Participating in the arts creates paths to healthy aging

“Researchers are highly interested in examining if and how participating in arts activities may be linked to improving cognitive function and memory and improving self-esteem and well-being. Scientists are also interested in studying how music can be used to reduce behavioral symptoms of dementia, such as stress, aggression, agitation, and apathy, as well as promoting social interaction, which has multiple psychosocial benefits,” said Lisa Onken, Ph.D., of NIA’s Division of Behavioral and Social Research.

Lifting their voices for healthy aging

“There’s a pressing need to develop novel, sustainable, and cost-effective approaches to improve the lives of older adults,” said Julene K. Johnson, Ph.D., of the University of California, San Francisco School of Nursing. “Singing in a community choir may be a unique approach to promote the health of diverse older adults by helping them remain active and engaged. It may even reduce health disparities.”

Dr. Johnson tested this approach, leading Community of Voices, the largest randomized clinical trial to test the impact of participating in a community choir on the health and well-being of nearly 400 culturally diverse adults, age 60 and older, from 12 senior centers in San Francisco. The centers were randomly chosen to conduct the choir program immediately (six intervention groups) or 6 months later (six control groups). Outcome measures were collected at baseline (prior to starting the intervention), 6 months (end of randomization phase), and 12 months (1 year after enrollment). Each choir met once a week in 90-minute sessions for 44 weeks and performed in several informal concerts.

At weekly rehearsals, professional choral directors from the San Francisco Community Music Center trained in the intervention led activities to promote health and well-being. Researchers assessed participants’ cognition, physical function, and psychosocial function, as well as their use and cost of healthcare services, before they started the choir program and again after 6 and 12 months.

Check out Community of Voices choirs in action: 

A unique aspect of the study was its use of community partners to engage, enroll, and retain a large group of racially and ethnically diverse and low-income older adults. Participants were recruited and completed all choir activities and assessments at the senior centers, which made it more convenient for them to join and continue in the study.

Participating in the community choir showed positive results within 6 months. In particular, it reduced feelings of loneliness and increased interest in life. However, cognitive and physical outcomes and healthcare costs did not change significantly. Dr. Johnson attributed the improvements to the choir providing a meaningful, regular opportunity to meet new people, build social support, and increase a sense of belonging.

“The study showed increased interest in life because singing in the choir provided a regular, structured activity for participants,” she said. “Access to regular activities in diverse, low-income communities is vital for older adults to remain active and engaged in their community.”

Dr. Onken noted, “By examining the mechanisms through which arts participation may provide benefits to health and well-being, and by studying arts participation with scientific rigor, we hope to establish a firm basis on which to develop programs to improve the health and well-being of older people. As these studies continue, we expect the results to show us how we can implement cost-effective, community-based programs that benefit older people.”

Theater improvising to cope with dementia

Northwestern University is looking to another art form, theater improvisation, to help older adults with early-stage dementia be social and improve their quality of life. “The Memory Ensemble” is for people newly diagnosed with Alzheimer’s disease and other types of dementia who are looking for opportunities to engage in programs that fit their needs,” said Darby Morhardt, Ph.D., Outreach, Recruitment and Education Core Leader at Northwestern’s Mesulam Center for Cognitive Neurology and Alzheimer’s Disease.

The Memory Ensemble’s 69 participants learn how to use their instincts, creativity, and spontaneity to explore and create improvisational theater. The program, developed in 2010 by Northwestern and the Lookingglass Theatre Company in Chicago, seeks to improve the quality of life for people living with Alzheimer’s and related disorders and to transfer these benefits to other communities.

As part of the 8-week program, groups of 10 to 15 participants, age 50 to 90, attend 90-minute sessions that are purposely repetitive and follow a specific pattern. Two facilitators—a clinical social worker and a master teaching artist in theater and improvisational techniques—guide participants through various activities.

The program does not aim to slow decline or improve cognition, but to help people with dementia enjoy their lives, according to Dr. Morhardt. “There are limits to medical treatments for people with dementia,” she said. “Patients and families are looking for ways to continue to engage. For participants in the program, it’s about being in the moment and using their imagination. We enhance their remaining skills and mood. As the condition progresses, it can become challenging to communicate with words, so we really focus on nonverbal means of expression.”

Preliminary results show participation in the Memory Ensemble improves mood, decreases anxiety, and increases a sense of belonging, normalcy, and destigmatization, said Dr. Dunford. Participants also report feelings of achievement, empowerment, and self-discovery.

Future plans include developing an evidence-based curriculum for researchers, arts therapists, and theater professionals to replicate the program in other communities and a theater intervention program for caregivers.

Research on music, theater, dance, creative writing, and other participatory arts shows promise for improving older adults’ quality of life and well-being, from better cognitive function, memory, and self-esteem to reduced stress and increased social interaction. NIA is addressing the need for more rigorous research, including new or alternative research designs and measurements that can demonstrate the efficacy and cost advantage of arts interventions.

Cheever T, Taylor A, Finkelstein R, et al. NIH/Kennedy Center workshop on music and the brain: Finding harmony. Neuron 2018;97(6):1214–1218.

Dunford CM, Yoshizaki-Gibbons HM, Morhardt D. The Memory Ensemble: Improvising connections among performance, disability, and ageing. Research in Drama Education 2017;22(3):420-426.

Johnson JK, Stewart AL, Acree M, et al. A community choir intervention to promote well-being among diverse older adults: Results from the Community of Voices trial. Journals of Gerontology: Series B. Published Nov. 9, 2018.

National Endowment for the Arts. The arts and aging: Building the science. (PDF, 2.3M) Summary of a National Academies workshop, “Research gaps and opportunities for exploring the relationship of the arts to health and well-being in older adults.” February 2013.