Arts for health initiatives: an emerging international agenda and evidence base for older populations

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During the past 10 years, there has been a developing arts for health agenda (Arts Council England 2007a, Arts Council England & Department of Health 2007b, Royal Society for Public Health 2012), with regional and national networks and international conferences (Health & Culture 2011, Arts, Health & Wellbeing Research Network 2012, Australian National Arts for Health Framework 2012, Clift 2012, National Center for Creative Aging 2013, North West Arts & Health Network 2013). Arts for health initiatives include museum and gallery in-reach and out-reach, singing projects and art installations in hospitals (Belfiore & Bennett 2008, Froggett & Little 2008, Chatterjee et al. 2009, Rosenberg 2009, Rosenberg et al. 2009, White 2009, Bungay et al. 2010, O'Neill 2010, Froggett et al. 2011, Health & Culture 2011, O'Shea & Leime 2012, Stickley 2012). Historically, the evidence base for the benefits of cultural arts for health initiatives has been limited (Staricoff 2004, O'Neill 2010, Camic & Chatterjee 2013), with most attention focused on the content and delivery of arts activities. However, it has long been known that buildings, windows and green spaces can affect health, well-being and recovery (Ulrich 1984, Gesler et al. 2004).

Current public policy promotes ‘active lives’ for older people and ageing populations to maintain independence, continue contributions to society and add to quality of life (Brown et al. 2004). Older people as citizens having rights to independence, participation, self fulfilment, care and dignity in their communities also forms part of this agenda (WHO 2002). In 2012, these policies were endorsed with ‘The European Year for Active Ageing’, which included plans for age friendly cities and environments, with accessible public buildings, transport and infrastructure along with promoting physical exercise, social engagement and inclusion and justice for older people (Valuing Older People 2009, Phillipson 2012, WHO 2012a). Ensuring a positive life experience is not only about promoting health and functional capacity in older people but also their social participation and security, which contribute to their overall quality of life and well-being (WHO 2012b). Lack of social interaction and loneliness can affect their quality of life for some older people (Victor et al. 2005, Scharf & de Jong Gierveld 2008).

In developed countries, older people are living longer and are more likely to live with several long-term conditions, with a majority continuing to live in their communities. However, for some, living with long-term conditions can result over time in a loss of function, disease, frailty and vulnerability and they may require additional support and care, which, for some, may be in care homes (WHO 2005, Knapp et al. 2007, p237, Phillips et al. 2010, Roy & Giddings 2012). Residents’ mood in care homes correlates with reported quality of life (Hoe et al. 2009), with those with dementia having significant unmet needs relating to a lack of stimulating daytime activities or company (Mozley et al. 2004, Hancock et al. 2006). Some care homes do offer a range of purposeful activities with anecdotal evidence from staff of benefit (Moos & Bjorn 2006) and are potential measures of quality in care homes (Mozley et al. 2004). Arts and creative activities for older people in care homes have the potential to improve health, quality of life and well-being as well as addressing inequalities for this vulnerable population (Belfiore 2002, Staricoff 2004, O'Neill 2010).

Arts for health initiatives are broader creative enterprises not intended as therapy, but which may well be therapeutic (Stickley 2012). They include performing visual and creative arts and medical humanities, such as music, singing, dance, reading and poetry groups as well as museum/gallery art and collections, creative writing, life story narrative-reminiscence, painting, printmaking, collage, pottery, sewing, knitting, woodwork or gardening. Some interventions include in-reach and out-reach with museums and galleries or voluntary groups along with artists that combine several creative activities or sessions (Global Alliance for Arts & Health 2013). The evidence base to inform such creative activities and programmes is emerging; however, rigorous evaluation and research evidence is required to support their continuing development and identify the benefits and outcomes on the quality of life and well-being (Clift 2012, Cameron et al. 2013, Camic & Chatterjee 2013).

There are few arts for health initiatives in hospital environments (Froggett & Little 2008, Chatterjee et al. 2009, Froggett et al. 2011). There is also some literature and debate on art, creativity and artists in old age (Dormandy 2000, O'Neill 2011). Receptive, listening to music, while in hospital has been shown to improve recovery from stroke and demonstrates the importance of arts and culture in well-being (Sarkamo et al. 2008). Of particular note and interest, therefore, is the qualitative study by Moss and O'Neill (2014) in this edition of JAN, which has investigated the aesthetic and cultural pursuits of older patients while they are in hospital, whether they experience aesthetic deprivation and the role arts and culture have in their lives and during their patient journey. As such, it is a valuable study that contributes to the limited body of evidence and is not only relevant for nurses caring for older people, whether in hospital or the community, but also nurse educators, health and social care providers and those involved with built environments. They report that impact of arts in hospital for older people is a neglected area, is beneficial and the timing need to relate to stage of illness and recovery and their previous interest and passions for arts, culture and leisure. Nurses in hospitals could lead this emerging area of work, collaborate with arts for health managers/curators and ensure that they are aware of the cultural and aesthetic interests of patients. Further research on arts for health initiatives in hospitals, care homes and communities is warranted to continue establishing the evidence base for quality of life and well-being and inform practice and programmes, in particular those involving inter-disciplinary teams and older people as participants and research partners.

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