Chapter 8.

Research on Art and Aging & A Review of the Literature

By Bruce Darling

  

Research on Art and Aging

While attending conferences and talking with people involved in the arts in health and care movement over the last few years, I have continually heard expressed the opinion that there is a dire need for more research to support the value of introducing art in health and care. The reasoning is most often that medical staff, care workers, facility management, funding sources all need to have solid evidence of the advantages for using limited resources on what they consider merely secondary time-filling activities. The so-called “gold standard” of quantitative reproducible scientific research that is standard in medical research is thought to be required to give legitimacy to the whole concept of introducing the arts into health and care. Yet people involved in these programs need no such evidence. They have seen with their own eyes and have talked with the families of those patients involved in such programs about the positive benefits that have accrued to individuals involved in these art programs. Moreover, I observed several exceptional programs where annual budgetary worries were not an issue. This is because these ongoing programs are funded by the largess of families who want others to be able to experience the benefits from the arts that their own loved ones experienced, whether in a nursing home, hospital, hospice. And what benefits are we talking about? Those participating in these various programs often become more outgoing, take less medication, smile more, feel better about themselves. In other words, their Quality of Life is better than before participating in these programs.

Concern about Quality of Life in health and care means that each person is given full attention with respect to his or her personal needs, physically, psychologically, socially. The whole person becomes the focus of health and care. This concern for Quality of Life is accompanied by the introduction of the Humanities in both education and practice in the health and care fields. This means that we are adding a different way of looking at things as compared with the biomedical and scientific model with its reductionism and dualism. The humanistic disciplines—the arts, literature, music, philosophy, history—are concerned with man and woman in the world. The methods for evaluating such art programs must reflect the nature of the humanistic disciplines involved. Emphasis is not only on the hard measurement of the world but also on soft reasoning with which we understand the world.[i] The humanistic disciplines attempt to understand the many dimensions of man and woman and their relationship with the world.

This holistic concern with the whole person means that the body and the mind are not to be treated as two distinct entities. The holistic approach to health and care, however, means much more than a non-dualistic view of mind and body. It also implies a consideration of a person’s family, social network, caretakers and natural and built environment. A person’s well being is contingent upon the state of this whole web of relationships. Moreover, the role of feelings, emotion, sentiment, mood are given their full consideration; when one feels happier one often gets better physically. Laughter has been shown to be good medicine.[ii] It is here that the arts can play a positive role.

The arts, whether the visual arts, performing arts, literary arts, best touch and reveal our deepest, innermost feelings. The power of art to stimulate, to communicate, to heal is without doubt. Perhaps it is the stories that art tells, the stories that art has that enables it to have such a powerful impact. Could these stories resonate with the biological processes that makes the telling of stories so much a part of what it means to be human? An attempt to grasp meaning, to understand.[iii] When looking into the value of the arts in health and care, then, we must consider not only quantitative evaluation. Certainly quantitative research has led to and continues to lead to gains in health and care that we can observe today. However, we must also look carefully at the qualitative approach. This is because we are concerned with Quality of Life, about how one feels about his or her circumstances. This is not something that can be easily reduced to numbers. We are not trying to measure the world but to understand it. We must consider the qualitative approach in which words play a central role. Stories need to be told; and stories need to be listened to. Descriptions are given and meaning is sought. In medicine, of course, there used to be no question about the importance of the narrative in clinical treatment. The current tendency to over rely on charts and data has led physicians away from listening to patient stories. The writing of case studies is becoming a lost art. Today this is beginning to be recognized and discussions of narrative are appearing in medical journals. Patient stories seem to be drawing more attention with respect to difficult to treat chronic illness. Paying attention to patient stories goes hand in hand with a holistic approach to treatment that has been traditionally central to medical practice and care work whether eastern or western. Perhaps it is the increasing attention being given to so-called alternative medicine that is bringing ideas of holistic treatment back into consideration by traditional western medicine.

Returning to the issue of research, of course solid scientific research supporting the introduction of the arts into health and care will always be important and it seems to be accumulating at a faster pace over the last several years. However, when I spoke with Gene Cohen about this problem he stated that if people still need to be convinced about the value of such art programs it is because they are not familiar with the research literature already available. Gene Cohen’s book entitled The Creative Age: Awakening Human Potential in the Second Half of Life introduces some of this important research by focusing on how healthy people age and the positive effects creativity can have.[iv] Clearly, the available research literature supporting the arts in health and care also needs to be made more readily accessible. This is now beginning to happen. For example, the NEA, on 1 July 2003, issued a report calling for greater involvement of the arts in Health Care. This extensive report includes a section on “Arts in Healthcare Research” that introduces twenty-seven examples of pilot and small and large population studies that are intended to indicate the scope and diversity of quality research on the arts in healthcare. [v]

Although the report also comments that there does not appear to be many long-term follow–through studies, I would like to refer readers to the work of Professor Lars Olov Bygren of Umea University, Sweden and his colleagues. These studies began with over 10,000 people and continued over a fourteen year period; the findings, to put it most simply, appear to indicate that people who are regularly involved in the arts in the manner of simply going to the cinema, concerts, museums or art exhibitions appear to live significantly longer than those who do not. Most surprisingly, variables such as age, sex, chronic illness, smoking, physical fitness, education, do not seem make any difference. The authors, though, are careful about drawing any definitive conclusions.[vi]

A different kind of evidence for the introduction of the arts into health and care

is also accumulating at an ever increasing rate—reports on various projects that people have been undertaking in the field. Although some still denigrate this as mere anecdotal evidence, the weight of the sheer numbers of successful projects is drawing more and more attention to this rapidly developing new approach to improving the lives of the elderly. Such project reports most commonly introduce the observed changes seen in the people participating in the various art programs. It seems to me that the stories of the individuals involved are worthy of being taken more seriously as positive evidence for continued funding. This means that narrative analysis should be explored to see if it can play a role in the qualitative research most suitable for evaluating arts programs and Quality of Life issues. (For more on narrative, see Professor Muteki’s paper on the importance of narrative in Oriental Medicine.)

I would also add, however, that many people in the field and out are clearly unaware of the possibilities of what the arts in health and care can do. One reason for this is perhaps that the involvement in the arts is beyond the spheres of experience of too many of these people as they were growing up. Moreover, the arts have not traditionally been a part of the medical school, nursing school, or care worker curricula. Based on recent press releases and newspaper articles this too is now beginning to change. We see the arts being made a part of the curriculum in medical schools in the United States, in Nursing programs in Sweden, in social work and care work curricula in Japan. Likewise do we find a dearth of the arts in the so-called activities programs that are used to keep the elderly busy. The various arts in healthcare societies in the United States, Europe and Japan are actively promoting such activities. Of course, one of the goals of this report is to throw light on some of the possibilities for implementing such programs.

From the above comments, we can see that convincing research on the arts in health and care will always be important, as is greater dissemination of that research; we also find that a more thoroughgoing arts curriculum reform is needed, both in general education as well in health and welfare education. Moreover, another most basic issue with respect to the role of the arts and culture in health and care also needs to be addressed. This is the issue of why there any question at all about the need for arts and culture in health and care. In Japan and in the United States people seem to have to fight very hard to bring the arts in health and care. The walls of nursery schools and kindergartens are regularly covered with the lively, gay and colorful art work of children. Hospice, as we have seen, is another venue where the arts are considered an essential component of life. Why are the arts not a regular part of everything in between? I have the impression that in Scandinavia and other countries in Europe the inclusion of the arts and culture in healthcare is not a question, but a given. It is only common sense that the arts continue to be a part of people’s lives, no matter what age. This is partially due to the place of the arts in education, but it is also due to the social democratic way the citizens of these nations look at their fellow human beings. For them, art and culture are an essential aspect of what it means to be human. In some respects it seems that Japan is closer to this kind of society than the United States. This means that here in Japan there are good possibilities of an ever greater role for the arts in health and care.

A Review of the Literature

Symposium and Conference Reports; Research Programs

Hospital Audiences, Inc. (HAI)

http://www.hospaud.org/hai/index.htm (accessed 11Jun2002)

(Michael Jon Spencer, Founder and Executive Director )

Live Arts Experiences: Their Impact on Health and Wellness , 3rd Edition

June 2000

PDF format available on-line:

URL: http://www.hospaud.org/hai/pubs/index.htm

Publication originally based on HAI’s 25th anniversary symposium “Hope

and Inspiration through the Arts: A Vision of Health, Healing,

and Wellness.”(1994)

Discusses the dynamics of live arts experiences, explores the issue of mediated culture through electronic and computer technology, and concludes with a section on health, wellness, and live arts experience. Includes a nine page bibliography.

Alan Dilani, editor.

Design and Health: The Therapeutic Benefits of Design

(2nd International Conference on Design and Health, 2000)

Stockhom: Svensk Byggtjänst, 2001

A collection of 35 studies on new approaches to healthcare design and the role

of art in healthcare by experts from Europe, the United States and Asia.

Francesca Turner and Peter Senior, editors

Culture, Health and the Arts Symposium—An Anthology

Manchester: The Manchester Metropolitan University, 2000

Subtitled “A powerful force for Good,” this anthology of 33 contributions to the World Symposium on Culture, Health and the Arts covers the whole spectrum of arts and health issues by participants from Great Britain and around the world (including Japan).

National Endowment for the Arts (NEA)

NEA Issues Report Calling for Greater Involvement of the Arts in Health Care

1 July 2003

The Arts in Healthcare Movement in the United States: Concept Paper

The Arts in Healthcare Symposium, March 19-20, 2003. Washington, DC

The recent symposium, hosted by the NEA and the Society for the Arts

in Healthcare, brought together 40 experts in medicine, the arts, social

services, media, business and government to develop a strategic plan

for advancing cultural programming in healthcare.

On-line: URL: http://arts.endow.gov/endownews/news03/AIHRelease.html

Appendix A: “ Examples of Arts in Healthcare Programs” presents a sampling of 27 of the hundreds of visual, literary and performing arts programs bringing arts into healthcare in the United States.

Appendix C: “Arts in Healthcare Research” introduces 37 examples of pilot and small and large population studies that are intended to indicate the scope and diversity of quality research on the arts in healthcare.

The NEA report includes the following statement at the beginning of its list of important research: “It is clear that, although there are discrete studies in a variety of areas of interest to the arts I healthcare movement, there do not appear to be many long-term follow-throughs with more studies on the same topic adding to solid research knowledge base.”

The following research by Professor Bygren and colleagues, not introduced in the NEA report, represent examples of long-term follow-through research.

Bygren, Lars Olov; Konlaan, Boinkum Benson; Lars Olov Bygren,Johansson, Sven-Erik,

“Attendance at cultural Events, reading books or periodicals, and making music or singing in a choir as determinants for survival: Swedish interview survey of living conditions,”

British Medical Journal (BMJ), 1996(21-28 December) Vol. 313, pp. 1577-80.

Sven Erik Johansson, Boinkum Benson Konlaan, and Lars Olov Bygren,

“Sustaining habits of attending cultural events and maintenance of health: a

longitudinal study,”

Health Promotion International , Vol. 16, No. 3, 229-234, September 2001

(Oxford University Press 2001)

http://heapro.oupjournals.org/cgi/content/full/16/3/229 (accessed on-line 15Nov2001)

Boinkum B. Konlaan, Lars O. Bygren, and Sven-Erik Johansson,

“Visiting the cinema, concerts, museums or art exhibitions as determinant of survival: a Swedish fourteen-year cohort follow-up”

Scandinavian Journal of Public Health (2000), 28, pp. 174-178.

BB Konlaan, N Björby, LO Bygren, G. Weissglas, LG Karlsson and M Widmark,

“Attendance at cultural events and physical exercise and health: a randomized controlled study,” Public Health (2000) 114, pp. 316-319

John Angus (Pioneer Projects (Celebratory Arts) Limited

An enquiry concerning Possible Methods for Evaluating Arts for Health Projects

This 79 page report was originally published by Community Health UK, 1999; it was reissued by CAHHM(Center for Arts and Humanities in Health and Medicine at University of Durham). Reference url: http://www.dur.ac.uk/cahhm/New-CAHHM-Publication.htm

This is a baseline study in the evaluation of community-based arts in health, written from an artist practitioner’s point of view. Evaluation has two main objectives: 1)to demonstrate the benefit –the outcome; 2) to assess the effectiveness of the working method—the process.

The Center for Arts and Humanities in Health and Medicine (CAHHM)

http://www.dur.ac.uk/cahhm/

CAHHM is a new research unit in Durham University's multi-disciplinary School For Health. CAHHM is building an evidence base for the effectiveness of the arts in healthcare, as well as developing the humanities in the training of medical students and other health professionals. CAHHM identifies and mentors arts in health programmes that are research-driven, assisting the implementation of evaluation methodologies that are suitable for arts, health and education sectors working in partnership. CAHHM has particular interests in community-based arts in health and in the human impact of art in healthcare architecture and design.

CAHHM,

14/15 Old Elvet, Durham, DH1 3HP.

Great Britain

Tel: 0191 334 6231

E-mail: cahhm.info@durham.ac.uk

Arts in Hospital and Care as Culture Research Program

(Kultur i varden och varden som kultur) 1994--present

Stockholm County Council

Birgitta Rapp. Research Director, Stockholms Läns Museum (Stockhom County Museum)

Forskningsprogrammet Research Programs 1994-1998

(allocation: SEK 10 million)

URL: http://www.lansmuseum.a.se/prog/omgamla.html (Swedish)

“A Presentation of Arts in Hospital and Care as Culture: Research Progam 1994-1998” is an English language publication that discusses the program, presents summaries of 27 research projects, and includes an extensive list of published materials and reports through October 1996.

Forskningsprogrammet Research Programs 2001-2005

URL: http://www.lansmuseum.a.se/prog/projekte.html (English)

This homepage introduces with a brief summaries a second group of 21

research projects currently being funded under the same ongoing Stockholm

County Council program.

The Stockholm County Council’s ongoing support for the Arts in Hospital

and Care as Culture Research Program irrespective of the party in power

indicates a broad recognition that art and culture have an important role to play in health and care. Making sure that the councilors understand the program is accomplished in part by their having face to face meetings with the researchers.

Also note that almost half of the 149 councilors are women. The United States, Japan and other countries have shown an interest in this model program.

See also, Birgitta Rapp, “Arts in Hospital & Care as Culture.” In Francesca Turner and Peter Senior, editors. Culture, Health and the Arts Symposium—An Anthology (Manchester: The Manchester Metropolitan University, 2000),

pp. 23-25

The Exeter Evaluation: Evaluation Research Project of Exeter Health Care Arts

Research and Report by Peter Senior and Peter Scher

Bowmoor House Royal Devon and Exeter Hospital

On-line. URL: http://www.ehca.org.uk/report.htm (accessed 9 April 2003

The first independent evaluation of a major hospital arts project, this report provides important data and new understandings about the interactions of patients and their families with the hospital environment. A premise of this study is that the hospital has a collection of art works that is placed on display within the hospital. An inventory is made, user’s(patients, staff, visitors) responses to specific works of art is surveyed, the effects on the healing process and therapeutic benefits is questioned. Human-centered quality healthcare environments is the goal architects, designers, artists-all those involved in such projects. Art works are but one element that contributes to the quality of an environment. This research is seeking to establish an evidenced-based evaluation of one such hospital arts project. Based on careful user assessment.

See also Peter Scher, “ The Exeter Evaluation-A Basis for Hospital Design and Art in the Millenium.” In Alan Dilani, ed. Design and Health: The Therapeutic Benefits of Design (2nd International Conference on Design and Health, 2000)

(Stockhom: Svensk Byggtjänst, 2001), pp. 317-327.

Charles Kaye and Tony Blee

The Arts in Health Care: A Palette of Possibilities

London: Jessica Kingsley Publishers, 1997

This book, now about five years old, describes current initiatives in the use of the arts in health and care. The goal is to provide people directly involved with health and care with practical approaches to setting up art programs in their own facilities. The book is not about art therapy as such, but rather on the therapeutic effects of art. Twenty-nine contributors cover various aspects on introducing the arts into health and care: getting started, involving the community, work with different kinds of groups such as older people or people with psychiatric problems, an international perspective, quality of care, evaluation issues (see the two entries below).

Malcolm Miles, “Does Art Heal? An Evaluative Approach to Art in

the Health Service.” In Charles Kaye and Tony Blee, editors.

The Arts in Health Care: A Palette of Possibilities (London:

Jessica Kingsley Publishers, 1997), pp.241-249.

Robin Philipp, “Evaluating the effectiveness of the Arts in Health

Care.” In Charles Kaye and Tony Blee, editors. The Arts in

Health Care: A Palette of Possibilities (London: Jessica

Kingsley Publishers, 1997), pp.250-261.

Gene D. Cohen

The Creative Age : Awakening Human Potential in the Second Half of Life

New York: Avon Books, 2000

 和訳:ジーン・D. コーエン (著), Gene D. Cohen (原著), 真野 明裕 (翻訳)

『なぜあの人はかくも元気なのか?—新しい生き方を見つける10の扉』 東京:光文社、2001。

On important aspect of aging that this book discusses is how recent discoveries in neuroscience have discovered that the brain maintains plasticity throughout its life, if it continues to be challenged. In other words, the brain needs stimulation to maintain its functioning and growth. Creativity, the desire to learn new things, to take up new challenges, is crucial.

Kotulak, Ronald

Inside the Brain: Revolutionary Discoveries of How the Mind Works

Kansas City: Andrews McMell Publishing, 1996

See especially chapters 15, 13, 12; also see sections on the brain’s

“plasticity,” defined on p. 150.

Cleveland, William

Art in Other Places: Artists at Work in America’s Community and Social Institutions

Westport, Connecticut: Praeger Publishers. 1992

Twenty-six chapters explore some of the roles art play in nursing homes and with the elderly, in prisons, and with the people with disabilities, in mental health facilities, in hospitals, and with youth at risk.

Sandel, Susan L. & Johnson, David Read

Waiting at the Gate: Creativity and Hope in the Nursing Home

New York/London: The Haworth Press, 1987.

(Also published as Activities, Adaption & Aging, Volume 9, Number 3, Spring 1987)

The gate as a metaphor marks the boundary between two states of being. The twelve chapters of this book explore how the arts can help people in nursing homes to make the transitions between the present and the past, between being passive and beings actively engaged, between remaining silent and expressing one’s feelings. Movement and drama are especially explored here.

Florence Nightingale,

Notes on Nursing: What it is and what it is not.

New York: Dover Publications, 1969

First published in the mid nineteenth century, Florence Nightingale’s Notes on Nursing remains of interest today because of the it covers the fundamental needs of patients that remain unchanged since Miss Nightingale’s day. The importance beauty, the role of art, the importance of a pleasant environment—these are but three of the subjects discussed here.

Roger Ulrich, Director, Center for Health Systems and Design, Texas A&M University, has published extensively on the relationship of building design, interior design, nature and art on health. His research article “View Through a Window May Influence Recovery from Surgery"(Science, Vol. 224, April 1984, pp. 420-421) helped to bring a new approach to the design of healthcare facilities. More extensive lists of his articles are found in the bibliographies of his research papers. Below I list but two.

Ulrich, Roger,

“The Effects of Viewing Art on Medical Outcomes”

in Culture, Health and the Arts-an Anthology

The Manchester Metropolitan University, 2000. Pp. 51-53.

Ulrich, Roger,

“Effects of Healthcare Environmental Design on Medical Outcomes.” In Alan Dilani, editor. Design and Health: The Therapeutic Benefits of Design (2nd International Conference on Design and Health, 2000) (Stockholm: Svensk Byggtjänst, 2001), pp. 49-59.

Selected Articles

Dawson AM, Baller WR.

“Relationship between creative activity and the health of elderly persons.”

J Psychol. 1972 Sep;82(1st Half):49-58.

Doric-Henry, Lee.

“Pottery as Art Therapy with Elderly Nursing Home Residents. Art Therapy”

Journal of the American Art Therapy Association ; v14 n3 p163-71 1997. 1997

Lane, Deforia,

“Effects of Music Therapy on Immune Function of Hospitalized Patients,”

Quality of Life, Vol. 3, No. 4 (year), pp. 74-80.

(demonstrates positive effects on IgA scores)

Linder, Erna Caplow, “Dance as a Therapeutic Intervention for the Elderly,” Educational Gerontology 8(2) 1982 (Special Issue: Gerontology and the Arts) pp. 167-174.

Ulrich, Roger S. “Effects of Gardens on Health Outcomes: Theory and Research.” In

Marcus , Clare Cooper and Barnes, Marni, ed., Healing Gardens: Therapeutic Benefits and Design Recommendations (New York: John Wiley & Sons, Inc., 1999), pp. 27-86

Wikstrom BM, Theorell T, Sandstrom S. “Psychophysiological effects of stimulation with pictures of works of art in old age.”

Int J Psychosom . 1992;39(1-4):68-75.

Wikstrom, B-M., Theorell, T. and Sandstrom, S. (1993)

“ Medical health and emotional effects of art stimulation in old age.”

Psychotherapy and Psychosomatics, 60, 195-206.

On Line Collections of Writings on Art and Aging

The Arts and Older Americans was originally published as a monograph by Americans for the Arts, with assistance from the National Endowment for the Arts.

On-line at: http://www.arts.endow.gov/partner/Accessibility/Monograph/OlderContents.html

Foreword

by Jane Alexander

Chair, National Endowment for the Arts

Articles

Arts Participation: The Greying of America, by Andrea Sherman

Arts Programs Uniting Generations, by Susan Perlstein

Opening Doors to Lifelong Learning in the Arts, by Paula Terry

Arts and Health Care for Older Adults, by Andrea Sherman

Arts, Legislation and Policy Considerations, by Bob Blancato

Reference material

How to Begin Involving Older Adults in the Arts

Checklist for Including Older Adults in Arts Programming

Arts and Aging Resources:

Bibliography

30 references on art and older Americans

Internet Sources on Aging

Organizations

Community Arts Network: Readings in Arts and Elders

URL: http://www.communityarts.net/readingroom/reseld.php

Includes the introductory essay “Arts and Creative Aging Across America

Overview of the field of arts and elders by director of Elders Share

the Arts; history, theory, personal perspective.” By Susan Perlstein

(2002).

“Reading Room Essays” (outside links) include ten articles, seven on dance, one by a performance artist, two on ESTA’s intergenerational programs.



[i] After Staffan Josephsson, “Narrative Thinking,” pp. 21-23; in Everyday Activities as Meeting Places in Dementia (Stockholm: Norstedts Trycheri AB, 1994).

[ii] See the following references:

Norman Cousins, Anatomy of an Illness as Perceived by the Patient:

Reflections on Healing and Regneration (New York: W.W. Norton &

Company, 2001)

Patch Adams, et al, Gesundheit!: Bringing Good Health to You, the Medical

System, and Society Through Physician Service, Complementary Therapies,

Humor, and Joy (Inner Traditions Intl. Ltd; Revised edition, 1998).

[iii] David B.Morris, Illness and Culture in the Postmodern Age (Berkeley, University of California Press, 1998); see the section on the chicken and snow shovel experiment, pp. 252-254.

[iv] Gene Cohen, The Creative Age: Awakening Human Potential in the Second Half of Life (New York: Avon Books, 2000).

[v] URL: http://arts.endow.gov/endownews03/AIHRelease.html.

[vi] For details, see the four articles by Professor Bygren, et al, under “Selected References.”



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