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Contents lists available at ScienceDirect
Maturitas journal homepage: www.elsevier.com/locate/maturitas
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Review
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Creativity in later life
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K.A. Pricea,∗ , A.M. Tinkerb a
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Barts and the London Medical School, Queen Mary University of London, United Kingdom Institute of Gerontology, Department of Social Science, Health and Medicine, King’s College London, United Kingdom
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Article history: Received 22 May 2014 Accepted 29 May 2014 Available online xxx
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Keywords: Creativity Creative activity Ageing Later life Older people
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Contents
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The ageing population presents significant challenges for the provision of social and health services. Strategies are needed to enable older people to cope within a society ill prepared for the impacts of these demographic changes. The ability to be creative may be one such strategy. This review outlines the relevant literature and examines current public health policy related to creativity in old age with the aim of highlighting some important issues. As well as looking at the benefits and negative aspects of creative activity in later life they are considered in the context of the theory of “successful ageing”. Creative activity plays an important role in the lives of older people promoting social interaction, providing cognitive stimulation and giving a sense of self-worth. Furthermore, it is shown to be useful as a tool in the multi-disciplinary treatment of health problems common in later life such as depression and dementia. There are a number of initiatives to encourage older people to participate in creative activities such as arts-based projects which may range from visual arts to dance to music to intergenerational initiatives. However, participation shows geographical variation and often the responsibility of provision falls to voluntary organisations. Overall, the literature presented suggests that creative activity could be a useful tool for individuals and society. However, further research is needed to establish the key factors which contribute to patterns of improved health and well-being, as well as to explore ways to improve access to services. © 2014 Published by Elsevier Ireland Ltd.
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Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Discussion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.1. Theories of ageing and creativity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.2. The benefits of creative activity in later life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.3. What creative activities do older people take part in? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.4. Barriers to creativity for older people . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.5. Creativity over the life course . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.6. Could creative activity be used therapeutically for illness in later life? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. Some policy Implications of creativity for active ageing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Competing interests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ethical approval . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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∗ Corresponding author. Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Turner Street, London E1 2AD, United Kingdom. Tel.: +44 7970811936. E-mail address: [email protected] (K.A. Price). http://dx.doi.org/10.1016/j.maturitas.2014.05.025 0378-5122/© 2014 Published by Elsevier Ireland Ltd.
Please cite this article in press as: Price http://dx.doi.org/10.1016/j.maturitas.2014.05.025
KA,
Tinker
AM.
Creativity
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1. Introduction
evidence are not precisely comparable and this must be considered when drawing conclusions from the evidence presented.
In 2010, the number of older people, over the age of 65, in the United Kingdom was estimated to be 10 million and is predicted to double by 2050 [1]. This presents a number of challenges for resource allocation and welfare provision. With many now surviving into their eighth decade, adaption of lifestyle to accommodate for ageing bodies and minds is vital within a society ill prepared for the impacts of these demographic changes. This transforms older people’s roles within society, the community and families as well as the services available for older people [2]. Through creativity, older people could potentially explore new endeavours, develop their sense of identity and cope better with the process of ageing [3]. Therefore, creative activity is one proposed coping mechanism for ageing individuals and populations. Creativity is defined as “the use of imagination or original ideas to create something” and has been considered by many wellrenowned thinkers, such as Aristotle and Einstein, to be an essential and innate part of human development [4]. Moreover, accessibility to art and cultural activities as part of a community is now considered a human right [5]. Creative activities should therefore be available for all ages to support health and well-being, as not only a natural part of human activity or as a way of developing and achieving, but as a basic human right. The definition of creative activity used here is taken from Kaufman & Sternburg [6] which states that creative activities should have three elements: innovation, valuable quality and appropriateness for the situation. Additional factors which will be taken into account include the notion that creative activities vary greatly between individuals, cultures and groups within society [7]; therefore creativity in old age should be considered by taking into account the diversity of the older population. The objectives of this review are: to explore the perspectives and participation of older people taking part in creative activities, to explore why different types of creative activity are beneficial for older people, and to examine society’s views on the use of creative activity in later life as a way of facilitating successful ageing. 2. Method This study is based on the literature. The inclusion criteria were articles published from 1980 to 2012 counting titles relevant to creative activity or creativities in participants mainly over the age of 65. All studies were included which met the inclusion criteria. Analysis of the grey literature was also reviewed including: policy documents, online literature and information leaflets. This review of the literature includes a variety of quantitative and qualitative studies in order to understand creativity in old age holistically. A systematic review of studies from a variety of journals was included, using the search terms listed below.
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Traditional methods of measuring the creative thought processes such as divergent thinking tests are criticised for lending only a brief idea of the cognitive processes involved in creative thinking. Whereas, the use of convergent thinking strategies to test creativity combine anecdotal evidence with laboratory experiments to gain a more representative measure of creative processing [8]. The studies considered here use a variety of these methods to understand the level of creativity individual participants have. Since there is no universal measure of creativity within research, the results of Please cite this article in press as: Price http://dx.doi.org/10.1016/j.maturitas.2014.05.025
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3. Discussion
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3.1. Theories of ageing and creativity
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The older population is diverse with the needs for older people ranging widely from active, well older people to those who are frail. Creativity as an activity is beneficial because it involves a broad range of interests and can be encouraged in those with all functional abilities. Due to these diversities society views of older people can impact on participation and availability of activities, therefore exploration of how we perceive ageing is necessary. Activity theory states that older people must remain active into retirement in order to maintain life satisfaction and resist declining health [9]. Evidence shows that older people can remain productive to society, providing they maintain good health and can access the resources needed to engage in daily activities [10]. Since the development of this theory, extensive research has shown the importance of activity in later life. The development of the hypothesis named successful ageing has also grown from this research into activity theory. Successful ageing is defined as: “low probability of disease and disease-related disability, high cognitive and physical functional capacity, and active engagement with life” [11]. This holistic view of ageing encourages older people to contribute to society and as a result gains medical and social benefits. However, this theory could also have a negative impact on older people from the exertion of pressure on them to resist social withdrawal, which can naturally occur with age. Activity theory and successful ageing theory can explain the benefits of creative activity for older people and are being used within policy to encourage participation in the community. Critical gerontology suggests that conflicts exist within successful ageing theories which can be seen by examining the origins of what is considered successful within society. The seemingly inevitable decline in functional ability and life satisfaction, which participation in activity can in theory prevent, is feared by many people as they grow older due to society’s idealisation of the young. If older people could age in the way they wish without the pressures of society we may see the positive sides of ageing more clearly. In this way, creativity could be a method of drawing out the positive aspects of ageing and encouraging older people to deal with ageing itself, instead of suggesting they appear younger through participation in activity [12]. On the other hand, creativity is an activity in itself and may help older people interpret and cope with ageing [13]. These healthy theoretical debates drive research into activity in later life, providing the evidence for the development of potentially beneficial policy and initiatives within the community. 3.2. The benefits of creative activity in later life
Creativity in later life, creativity in old age, creative activity in later life, creative activity in old age, old age and creativity, activity in later life.
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The positive impact of activity in later life for health and wellbeing is well established within research. A comparative study of 300 American participants showed that community based arts increased general health, reduced the amount of doctors’ visits and reduced the need for additional medication [13]. In addition to health improvements, social activities are linked to improved well-being and life satisfaction [14]. However, the specific aspects of activity which are responsible for these improvements are less clear. The literature suggests that social engagement plays a key role in reducing loneliness, maintaining life satisfaction and improving health outcomes [15]. In this way, regular activities can increase social networks and communication for those isolated in the Tinker
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community. Moreover social interaction has been shown, in a cohort study of 1138 older people, to significantly reduce the rate of cognitive decline over the 5 years following retirement [16]. However, the long-term effects of activity on cognition are not clear. Another key aspect which is shown to improve health in older people is physical activity. The World Health Organisation recommends physical activity for all older people to reduce risk of falls, improve health and increase well-being [17]. Wang et al. [18] in a large 3-year follow up study of 1463 older adults in China found that mental, physical and social activities are all key factors in reducing cognitive decline. However longer follow periods are necessary in order to understand true benefits. Despite these shortcomings it is apparent that physical and social activity in later life contributes significantly to successful ageing. Evidence suggests that centenarians maintain a passion for creativity, despite their age, enabling them to remain mentally and physically active [19]. Additionally, Katz et al. [20] suggests that the value of creative activity lies with preserving contact with the outside world, developing self-determination and engaging in social interaction. Moreover, the Mental Health Foundation has recommended supporting communities to provide targeted services for the older population to improve mental health [21]. Overall, the evidence presented here suggests that many aspects of creative activities can be beneficial for older people, including maintenance of leisure activities, social interaction, mental and physical activity and the encouragement of self-motivation.
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3.3. What creative activities do older people take part in?
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A report from 80 participants in the national survey of quality of life (2004) showed that 90% of older people engage in hobbies or leisure activities regularly [22]. Some of these activities, ranging from state funded to voluntary services, are outlined by the Baring Arts foundation [23]. For example an Age Concern Cheshire project “Wear purple arts” provides professional artist run workshops in music and visual arts for people over the age of 55, in day care centres and residential homes [24]. Larger projects such as Live Music Now’s: “Active Music, Active Minds” run music based sessions UK-wide which focus on enjoyment and social interaction through music [25]. Lally [26] examined the impact of the “Sweet tonic programme” the findings showed improvement in fitness, flexibility, mood and self-esteem associated with singing weekly in a choir. Dabback [27] furthers this by suggesting that participating in musical activities provide structure and purpose for older people. Much of the benefits of these activities re-occur between domains, with both music and visual arts providing purpose and social interaction. Although the benefits of such projects are well documented, the availability of these projects to all older people remains geographical and the numbers of people who are accessing these services are unknown. Qualitative research has the benefit of exploring the views and experiences of older people. For instance, those participating in art exhibitions found it enhanced their self-expression, confidence and gave them the opportunity to learn new skills [28]. A study of 32 older amateur artists showed that creativity can inspire fresh ambition, ensuring a valued connection to the world, whilst removing negative stereotypes of ageing and building community connections [29]. Intergenerational projects use art based programmes to successfully encourage interaction between the young and the old, with aims to challenge preconceived attitudes, enhance enjoyment and build ongoing relationships [30]. However, the community cohesion and acceptance of others which is encouraged through creative activities between socially and culturally distinct group of people can not only benefit older and younger people, but also bring together more isolated and down trodden members of Please cite this article in press as: Price http://dx.doi.org/10.1016/j.maturitas.2014.05.025
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society, such as refugees who can also be experiencing ageing and poor health [31]. The evidence to support the benefits of creative activity in later life of many domains is convincing. However, it could be argued that the benefits shown from creative activity stem from the social integration and community interaction, as opposed to the creativity itself. Whilst, social activity may well contribute to the benefits of creative activity it is shown that solitary creative activities improve self-rated happiness and contribute to successful ageing [32]. Further research is needed to establish the key factors which contribute to the benefits of creative activity in order to optimise programmes offered to older people. Additionally, larger scale longitudinal studies are needed to fully appreciate the benefits to individuals and its impact on general health and well-being of the older population. 3.4. Barriers to creativity for older people
3.5. Creativity over the life course
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There are many factors which contribute to creative cognition; for instance problem solving [37], flexible thinking [38] and memory retrieval which all decline with age [39]. These factors are shown to decline with age. However, old age may simply represents a different kind of creativity [40], with numerous artistic masters have created their best work in later life, for instance Monet’s “Water lilly” collections painted in his last decade of life. Recent evidence suggests that when age differences in working memory are taken into account, the trend of declining ability to think creatively with advancing age is no longer apparent [41]. The ageing brain could even be better suited to creative activity; older mind being more distractible and dis-inhibited leading to increased creative thought [42,43]. Longitudinal studies which measure creative output across the lifespan suggest that productivity increases rapidly up to 20 years and declines thereafter [44]. Additionally, Simonton AM.
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The challenges of engaging in creativity have not been considered extensively within research. It could be assumed that creative activities are more readily available to those with the functional ability and financial security to support their own interests; thus the experience of ageing is not universal. With advancing age, activities tend to be more solitary and more often within the home environment. As such, the social benefits of activities cannot be fully gained [33]. One in six older people are shown to be socially disengaged (2012) leading to impoverished social networks and limited leisure involvement [34] and these individuals are more likely to have a lower socio-economic status [34]. Education and socio-economic status play a central role in the ability to access leisure activities; this may also be applicable to creative activities. Moreover, in 2010–2011 on average 48% of older people were not engaging in any leisure activities and 40% of men and 37% of women were culturally disengaged [35]. Therefore a considerable proportion of older people, who are most likely of lower socio-economic status, are socially isolated and detached from potentially beneficial activities either through choice or inaccessibility. Additionally, there may be geographical inconsistency in the provision of services. Regrettably, those unable to reach services, such as isolated individuals living in poverty, may be those who would benefit most. In the current economic climate arts-based activities are not prioritised in state funding, meaning the benefits of creative activity on health and well-being may not be seen. Nevertheless, the broad nature of creativity mean that available to all in one way or another is possible; spanning from activity classes to listening to music on the radio. However the ability to engage with activities, in order to gain these benefits, can decline with age as cognitive function declines [36]. These barriers must be considered when implementing creative activities so the benefits can be maximised.
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[45] found that the quality of work improved while quantity decreased, but these trends vary between individuals. Peter Laslett [46] remarked that the “Third age” enables a generation surrounded by a consumer culture to embark on retirement by expanding and extending their leisure interests. Overall, creativity is a personal and multi-faceted process which benefits quality of life, can aid coping with the experience of ageing and improve health outcomes and therefore should be encouraged.
3.6. Could creative activity be used therapeutically for illness in later life? Major depression affects up to 9.4% of older people living in the community and 42% of those living in Institutions [47]. These are factors lead to poor mental and physical health [48]. Evidence from semi-structured interviews, with 26 older people with depression and social isolation at baseline, shows that encouragement of creative activity can significantly improve depression, confidence and social support at 12 months [49]. However, it has also been suggested that depression can moderate the benefits of creative activity for successful ageing, especially in those from ethnic minorities or low educational level [50]. Therefore, the linked relationship between creative activity, depression and social isolation is difficult to establish true causality. For example, does a lack of involvement in creative activity lead to depression? Or does depression cause people to reduce their involvement in social activities? It could be argued that causality is not essential to establish because creative activity is shown to improve depressive symptoms and provide social support. In this way, creative activity could be offered to older people with depression or social isolation to improve quality of life and general health. However, more evidence is needed, from larger scale trials, to examine the potential benefits and practicalities of these creative activities as a conservative treatment for depression in older people. Furthermore, the use of musical and art therapy in palliative care relieves some suffering. Evidence suggests that music therapy relieves pain and psychological suffering [51]; whereas, visual art making improves symptom control, quality of life and coping in cancer patients [52]. For these reasons creativity as a psychological intervention can be used for many other mental and physical conditions. The benefits of these therapies could be used to provide support for frail or unwell older people to cope with ageing. Case studies presented by Johnson & Sullivan-Marx [53] demonstrate the how art therapy can help older people cope with the challenges of ageing by instilling hope, aiding communication, allowing management of emotions and encouraging life review. The use of creative activity in the care of dementia patients is a hot topic in Gerontology research. As mentioned earlier, creative activity can reduce the normal cognitive decline associated with ageing [54], but could it be used to slow cognitive decline with the pathological process of dementia? The impact of creative activity on the rate of cognitive decline in people with dementia is unknown. However, intensive creative therapies over 8 weeks (dance, drama, music and movement) are shown to improve communication, selfexpression and engagement in patients with dementia in the short term, but more evidence is needed to investigate potential long term benefits [55]. Creative and sensory therapy is recommended by the charitable organisation, Mind, to encourage relaxation, emotion, expression and communication for people with all mental illness, including dementia [56]. In this way, art and music therapy can be used to treat symptoms and improve the experience for people. This could mean that creative therapies could help older people cope with the normal physiological changes which occur with ageing.
Please cite this article in press as: Price http://dx.doi.org/10.1016/j.maturitas.2014.05.025
KA,
4. Some policy Implications of creativity for active ageing Over the last 20 years, theories of active ageing have been adopted into policy. The term active ageing was originally defined by the WHO [57] as “the process of optimising opportunities for health, participation and security in order to enhance quality of life as people age”. Active ageing is seen by the European Union (EU) as a key political model to lessen the impact of demographic change [58]. This policy framework aims to encourage activity in later life within a supportive social environment [57]. Therefore, as being active in later life has been politically encouraged so strongly, it is important to assess ways in which healthcare, social care, communities and families can provide opportunities for older people to remain active. European Union Guidelines on promoting active ageing in Europe, aim to accelerate the implementation of active ageing policies to ensure quality of life for older people is improving and will be sustained [59]. However the European Commission have subsequently stated that “In many countries, policies fostering active and healthy ageing have been rather modest and short of the necessary disease preventing and health promoting measures” [60]. Reasons might be that they are not appealing and mainly concentrate on physical activity. Creativity as part of active ageing is predominantly promoted by charitable organisations, but also by some local authorities. Age UK endorse the arts as part of the “leisure and learning” guidelines to encourage older people to access creative activities, promoting active ageing [61]. An example of local government implementing this policy is the Welsh Assembly Government and Welsh Arts Council publication “Arts in Health and Wellbeing: an Action Plan for Wales” which aids professionals in adapting the arts into healthcare and the community [62]. Although the positive impact of implementation in the field of active ageing is encouraging, policy specifically promoting creativity in old age is limited and mainly left to the voluntary sector.
5. Conclusion
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In the context of the ageing population, what it means to be “old” is changing. The older population is becoming increasingly diverse, with many retired people remaining active and contributing to society, whilst others suffer from deteriorating health and functional ability. Polices from the WHO, EU and British Government encourage older people to remain active in order to maintain health, well-being and ability well into later life. Creative activity is shown to play a role in maintaining mental and physical health, selfworth and social interaction [20]. Despite alterations in cognitive processing with age which decrease problem-solving ability and information retrieval, it can be argued that the older mind is more adept to imaginative thinking with increased distractibility and disinhibition. Studies in showing creativity across the lifespan even suggest that in later life, despite a decline in quantity of work by professional artists, the quality and accreditation of work increases with age. Therefore creative activity could provide older people with opportunity to develop new skills, achieve success and provide cognitive stimulation. The English Longitudinal Study of Ageing suggests that in the UK the number of activities people undertake outside the home declines with age [33]. Additionally, older people who are socially isolated, poor and have declining health status are the least likely to engage in activity [34], in spite of the fact that they may benefit the most. Therefore, even though creative activity is encouraged within policy and the number of opportunities available for creative activity outside the home is growing, the evidence suggests that many older people are unable to access these services. Therefore, future research is required to understand and develop Tinker
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programmes more appropriate and accessible for older people to reach them. The benefits of creative activity itself, ranging from visual arts to musical activity, have been explored extensively within the literature. The evidence reviewed here suggest that community based programmes encourage social integration, reduce stigmatisation, improve well-being, fitness and self-esteem. However, the provision of creative activities is not universal across UK. There is potential that the well and wealthy could access these opportunities for creative activity and those less able to access services will fail to benefit from them especially with an economic climate in which arts-based activities are not a priority. Nevertheless, if the knowledge that creative activity can benefit older people was more wide-spread, then all older people could endeavour to introduce a little creativity into later life, even through listening to the radio or engaging in creative session once in a while and experience the proven benefits. Creativity is even considered an evidence based treatment to improve self-esteem, promote achievement and develop social networks for those who are depressed or socially isolated. Moreover, within palliative care musical and arts based therapies can improve pain management and psychological well-being. Arts based therapies could be used as a conservative approach to help older people cope with the ageing process, as well as dealing with declining health and function which could potentially improve pain management in chronic conditions reducing the need for medication, reduce social isolation or depression and generally improve quality of life. These ideas could be explored in future research in order to provide alternative treatment for older people and reduce the need for expensive medical treatments. Overall, the literature presented suggests that creative activity could be a useful tool for individuals and society within the ageing population. However, further research is needed to establish the key factors in creative activities which contribute to patterns of improved health and well-being, as well as to explore ways to improve access to services and ways in which arts-based activities can be optimised to improve quality of life for older people.
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Mental exercise and mental ageing: evaluating the validity of the “use or lose it” hypothesis. Perspect Psychol Sci 2006;1(1):68–87. [40] Sasser-Coen JR. Qualitative changes in creativity in the second half of life a life-span developmental perspective; 1993. [41] Roskos-Ewoldsen B, Black SR, McCown SM. Age-related changes in creative thinking; 2011. [42] Carson SH. Creativity and the ageing brain; 2009 http://www.psychologytoday. com/blog/life-art/200903/creativity-and-the-aging-brain [accessed 12.06.13]. [43] Hasher L, Zacks RT. Aging and a benefit of distractibility. Psychonomic Bull Rev 2008;14:301–5. [44] Roskos-Ewoldsen B, Black S, McCown S. Age related change in creative thinking. J Creativ Behav 2011;42(1):33–59.
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Contents lists available at ScienceDirect
Maturitas journal homepage: www.elsevier.com/locate/maturitas
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Review
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Creativity in later life
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K.A. Pricea,∗ , A.M. Tinkerb a
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Barts and the London Medical School, Queen Mary University of London, United Kingdom Institute of Gerontology, Department of Social Science, Health and Medicine, King’s College London, United Kingdom
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a r t i c l e
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Article history: Received 22 May 2014 Accepted 29 May 2014 Available online xxx
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Keywords: Creativity Creative activity Ageing Later life Older people
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Contents
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The ageing population presents significant challenges for the provision of social and health services. Strategies are needed to enable older people to cope within a society ill prepared for the impacts of these demographic changes. The ability to be creative may be one such strategy. This review outlines the relevant literature and examines current public health policy related to creativity in old age with the aim of highlighting some important issues. As well as looking at the benefits and negative aspects of creative activity in later life they are considered in the context of the theory of “successful ageing”. Creative activity plays an important role in the lives of older people promoting social interaction, providing cognitive stimulation and giving a sense of self-worth. Furthermore, it is shown to be useful as a tool in the multi-disciplinary treatment of health problems common in later life such as depression and dementia. There are a number of initiatives to encourage older people to participate in creative activities such as arts-based projects which may range from visual arts to dance to music to intergenerational initiatives. However, participation shows geographical variation and often the responsibility of provision falls to voluntary organisations. Overall, the literature presented suggests that creative activity could be a useful tool for individuals and society. However, further research is needed to establish the key factors which contribute to patterns of improved health and well-being, as well as to explore ways to improve access to services. © 2014 Published by Elsevier Ireland Ltd.
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Q2
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Discussion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.1. Theories of ageing and creativity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.2. The benefits of creative activity in later life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.3. What creative activities do older people take part in? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.4. Barriers to creativity for older people . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.5. Creativity over the life course . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.6. Could creative activity be used therapeutically for illness in later life? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. Some policy Implications of creativity for active ageing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Competing interests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ethical approval . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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∗ Corresponding author. Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Turner Street, London E1 2AD, United Kingdom. Tel.: +44 7970811936. E-mail address: [email protected] (K.A. Price). http://dx.doi.org/10.1016/j.maturitas.2014.05.025 0378-5122/© 2014 Published by Elsevier Ireland Ltd.
Please cite this article in press as: Price http://dx.doi.org/10.1016/j.maturitas.2014.05.025
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evidence are not precisely comparable and this must be considered when drawing conclusions from the evidence presented.
In 2010, the number of older people, over the age of 65, in the United Kingdom was estimated to be 10 million and is predicted to double by 2050 [1]. This presents a number of challenges for resource allocation and welfare provision. With many now surviving into their eighth decade, adaption of lifestyle to accommodate for ageing bodies and minds is vital within a society ill prepared for the impacts of these demographic changes. This transforms older people’s roles within society, the community and families as well as the services available for older people [2]. Through creativity, older people could potentially explore new endeavours, develop their sense of identity and cope better with the process of ageing [3]. Therefore, creative activity is one proposed coping mechanism for ageing individuals and populations. Creativity is defined as “the use of imagination or original ideas to create something” and has been considered by many wellrenowned thinkers, such as Aristotle and Einstein, to be an essential and innate part of human development [4]. Moreover, accessibility to art and cultural activities as part of a community is now considered a human right [5]. Creative activities should therefore be available for all ages to support health and well-being, as not only a natural part of human activity or as a way of developing and achieving, but as a basic human right. The definition of creative activity used here is taken from Kaufman & Sternburg [6] which states that creative activities should have three elements: innovation, valuable quality and appropriateness for the situation. Additional factors which will be taken into account include the notion that creative activities vary greatly between individuals, cultures and groups within society [7]; therefore creativity in old age should be considered by taking into account the diversity of the older population. The objectives of this review are: to explore the perspectives and participation of older people taking part in creative activities, to explore why different types of creative activity are beneficial for older people, and to examine society’s views on the use of creative activity in later life as a way of facilitating successful ageing. 2. Method This study is based on the literature. The inclusion criteria were articles published from 1980 to 2012 counting titles relevant to creative activity or creativities in participants mainly over the age of 65. All studies were included which met the inclusion criteria. Analysis of the grey literature was also reviewed including: policy documents, online literature and information leaflets. This review of the literature includes a variety of quantitative and qualitative studies in order to understand creativity in old age holistically. A systematic review of studies from a variety of journals was included, using the search terms listed below.
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Traditional methods of measuring the creative thought processes such as divergent thinking tests are criticised for lending only a brief idea of the cognitive processes involved in creative thinking. Whereas, the use of convergent thinking strategies to test creativity combine anecdotal evidence with laboratory experiments to gain a more representative measure of creative processing [8]. The studies considered here use a variety of these methods to understand the level of creativity individual participants have. Since there is no universal measure of creativity within research, the results of Please cite this article in press as: Price http://dx.doi.org/10.1016/j.maturitas.2014.05.025
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3. Discussion
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The older population is diverse with the needs for older people ranging widely from active, well older people to those who are frail. Creativity as an activity is beneficial because it involves a broad range of interests and can be encouraged in those with all functional abilities. Due to these diversities society views of older people can impact on participation and availability of activities, therefore exploration of how we perceive ageing is necessary. Activity theory states that older people must remain active into retirement in order to maintain life satisfaction and resist declining health [9]. Evidence shows that older people can remain productive to society, providing they maintain good health and can access the resources needed to engage in daily activities [10]. Since the development of this theory, extensive research has shown the importance of activity in later life. The development of the hypothesis named successful ageing has also grown from this research into activity theory. Successful ageing is defined as: “low probability of disease and disease-related disability, high cognitive and physical functional capacity, and active engagement with life” [11]. This holistic view of ageing encourages older people to contribute to society and as a result gains medical and social benefits. However, this theory could also have a negative impact on older people from the exertion of pressure on them to resist social withdrawal, which can naturally occur with age. Activity theory and successful ageing theory can explain the benefits of creative activity for older people and are being used within policy to encourage participation in the community. Critical gerontology suggests that conflicts exist within successful ageing theories which can be seen by examining the origins of what is considered successful within society. The seemingly inevitable decline in functional ability and life satisfaction, which participation in activity can in theory prevent, is feared by many people as they grow older due to society’s idealisation of the young. If older people could age in the way they wish without the pressures of society we may see the positive sides of ageing more clearly. In this way, creativity could be a method of drawing out the positive aspects of ageing and encouraging older people to deal with ageing itself, instead of suggesting they appear younger through participation in activity [12]. On the other hand, creativity is an activity in itself and may help older people interpret and cope with ageing [13]. These healthy theoretical debates drive research into activity in later life, providing the evidence for the development of potentially beneficial policy and initiatives within the community. 3.2. The benefits of creative activity in later life
Creativity in later life, creativity in old age, creative activity in later life, creative activity in old age, old age and creativity, activity in later life.
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The positive impact of activity in later life for health and wellbeing is well established within research. A comparative study of 300 American participants showed that community based arts increased general health, reduced the amount of doctors’ visits and reduced the need for additional medication [13]. In addition to health improvements, social activities are linked to improved well-being and life satisfaction [14]. However, the specific aspects of activity which are responsible for these improvements are less clear. The literature suggests that social engagement plays a key role in reducing loneliness, maintaining life satisfaction and improving health outcomes [15]. In this way, regular activities can increase social networks and communication for those isolated in the Tinker
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community. Moreover social interaction has been shown, in a cohort study of 1138 older people, to significantly reduce the rate of cognitive decline over the 5 years following retirement [16]. However, the long-term effects of activity on cognition are not clear. Another key aspect which is shown to improve health in older people is physical activity. The World Health Organisation recommends physical activity for all older people to reduce risk of falls, improve health and increase well-being [17]. Wang et al. [18] in a large 3-year follow up study of 1463 older adults in China found that mental, physical and social activities are all key factors in reducing cognitive decline. However longer follow periods are necessary in order to understand true benefits. Despite these shortcomings it is apparent that physical and social activity in later life contributes significantly to successful ageing. Evidence suggests that centenarians maintain a passion for creativity, despite their age, enabling them to remain mentally and physically active [19]. Additionally, Katz et al. [20] suggests that the value of creative activity lies with preserving contact with the outside world, developing self-determination and engaging in social interaction. Moreover, the Mental Health Foundation has recommended supporting communities to provide targeted services for the older population to improve mental health [21]. Overall, the evidence presented here suggests that many aspects of creative activities can be beneficial for older people, including maintenance of leisure activities, social interaction, mental and physical activity and the encouragement of self-motivation.
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3.3. What creative activities do older people take part in?
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A report from 80 participants in the national survey of quality of life (2004) showed that 90% of older people engage in hobbies or leisure activities regularly [22]. Some of these activities, ranging from state funded to voluntary services, are outlined by the Baring Arts foundation [23]. For example an Age Concern Cheshire project “Wear purple arts” provides professional artist run workshops in music and visual arts for people over the age of 55, in day care centres and residential homes [24]. Larger projects such as Live Music Now’s: “Active Music, Active Minds” run music based sessions UK-wide which focus on enjoyment and social interaction through music [25]. Lally [26] examined the impact of the “Sweet tonic programme” the findings showed improvement in fitness, flexibility, mood and self-esteem associated with singing weekly in a choir. Dabback [27] furthers this by suggesting that participating in musical activities provide structure and purpose for older people. Much of the benefits of these activities re-occur between domains, with both music and visual arts providing purpose and social interaction. Although the benefits of such projects are well documented, the availability of these projects to all older people remains geographical and the numbers of people who are accessing these services are unknown. Qualitative research has the benefit of exploring the views and experiences of older people. For instance, those participating in art exhibitions found it enhanced their self-expression, confidence and gave them the opportunity to learn new skills [28]. A study of 32 older amateur artists showed that creativity can inspire fresh ambition, ensuring a valued connection to the world, whilst removing negative stereotypes of ageing and building community connections [29]. Intergenerational projects use art based programmes to successfully encourage interaction between the young and the old, with aims to challenge preconceived attitudes, enhance enjoyment and build ongoing relationships [30]. However, the community cohesion and acceptance of others which is encouraged through creative activities between socially and culturally distinct group of people can not only benefit older and younger people, but also bring together more isolated and down trodden members of Please cite this article in press as: Price http://dx.doi.org/10.1016/j.maturitas.2014.05.025
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society, such as refugees who can also be experiencing ageing and poor health [31]. The evidence to support the benefits of creative activity in later life of many domains is convincing. However, it could be argued that the benefits shown from creative activity stem from the social integration and community interaction, as opposed to the creativity itself. Whilst, social activity may well contribute to the benefits of creative activity it is shown that solitary creative activities improve self-rated happiness and contribute to successful ageing [32]. Further research is needed to establish the key factors which contribute to the benefits of creative activity in order to optimise programmes offered to older people. Additionally, larger scale longitudinal studies are needed to fully appreciate the benefits to individuals and its impact on general health and well-being of the older population. 3.4. Barriers to creativity for older people
3.5. Creativity over the life course
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There are many factors which contribute to creative cognition; for instance problem solving [37], flexible thinking [38] and memory retrieval which all decline with age [39]. These factors are shown to decline with age. However, old age may simply represents a different kind of creativity [40], with numerous artistic masters have created their best work in later life, for instance Monet’s “Water lilly” collections painted in his last decade of life. Recent evidence suggests that when age differences in working memory are taken into account, the trend of declining ability to think creatively with advancing age is no longer apparent [41]. The ageing brain could even be better suited to creative activity; older mind being more distractible and dis-inhibited leading to increased creative thought [42,43]. Longitudinal studies which measure creative output across the lifespan suggest that productivity increases rapidly up to 20 years and declines thereafter [44]. Additionally, Simonton AM.
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The challenges of engaging in creativity have not been considered extensively within research. It could be assumed that creative activities are more readily available to those with the functional ability and financial security to support their own interests; thus the experience of ageing is not universal. With advancing age, activities tend to be more solitary and more often within the home environment. As such, the social benefits of activities cannot be fully gained [33]. One in six older people are shown to be socially disengaged (2012) leading to impoverished social networks and limited leisure involvement [34] and these individuals are more likely to have a lower socio-economic status [34]. Education and socio-economic status play a central role in the ability to access leisure activities; this may also be applicable to creative activities. Moreover, in 2010–2011 on average 48% of older people were not engaging in any leisure activities and 40% of men and 37% of women were culturally disengaged [35]. Therefore a considerable proportion of older people, who are most likely of lower socio-economic status, are socially isolated and detached from potentially beneficial activities either through choice or inaccessibility. Additionally, there may be geographical inconsistency in the provision of services. Regrettably, those unable to reach services, such as isolated individuals living in poverty, may be those who would benefit most. In the current economic climate arts-based activities are not prioritised in state funding, meaning the benefits of creative activity on health and well-being may not be seen. Nevertheless, the broad nature of creativity mean that available to all in one way or another is possible; spanning from activity classes to listening to music on the radio. However the ability to engage with activities, in order to gain these benefits, can decline with age as cognitive function declines [36]. These barriers must be considered when implementing creative activities so the benefits can be maximised.
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[45] found that the quality of work improved while quantity decreased, but these trends vary between individuals. Peter Laslett [46] remarked that the “Third age” enables a generation surrounded by a consumer culture to embark on retirement by expanding and extending their leisure interests. Overall, creativity is a personal and multi-faceted process which benefits quality of life, can aid coping with the experience of ageing and improve health outcomes and therefore should be encouraged.
3.6. Could creative activity be used therapeutically for illness in later life? Major depression affects up to 9.4% of older people living in the community and 42% of those living in Institutions [47]. These are factors lead to poor mental and physical health [48]. Evidence from semi-structured interviews, with 26 older people with depression and social isolation at baseline, shows that encouragement of creative activity can significantly improve depression, confidence and social support at 12 months [49]. However, it has also been suggested that depression can moderate the benefits of creative activity for successful ageing, especially in those from ethnic minorities or low educational level [50]. Therefore, the linked relationship between creative activity, depression and social isolation is difficult to establish true causality. For example, does a lack of involvement in creative activity lead to depression? Or does depression cause people to reduce their involvement in social activities? It could be argued that causality is not essential to establish because creative activity is shown to improve depressive symptoms and provide social support. In this way, creative activity could be offered to older people with depression or social isolation to improve quality of life and general health. However, more evidence is needed, from larger scale trials, to examine the potential benefits and practicalities of these creative activities as a conservative treatment for depression in older people. Furthermore, the use of musical and art therapy in palliative care relieves some suffering. Evidence suggests that music therapy relieves pain and psychological suffering [51]; whereas, visual art making improves symptom control, quality of life and coping in cancer patients [52]. For these reasons creativity as a psychological intervention can be used for many other mental and physical conditions. The benefits of these therapies could be used to provide support for frail or unwell older people to cope with ageing. Case studies presented by Johnson & Sullivan-Marx [53] demonstrate the how art therapy can help older people cope with the challenges of ageing by instilling hope, aiding communication, allowing management of emotions and encouraging life review. The use of creative activity in the care of dementia patients is a hot topic in Gerontology research. As mentioned earlier, creative activity can reduce the normal cognitive decline associated with ageing [54], but could it be used to slow cognitive decline with the pathological process of dementia? The impact of creative activity on the rate of cognitive decline in people with dementia is unknown. However, intensive creative therapies over 8 weeks (dance, drama, music and movement) are shown to improve communication, selfexpression and engagement in patients with dementia in the short term, but more evidence is needed to investigate potential long term benefits [55]. Creative and sensory therapy is recommended by the charitable organisation, Mind, to encourage relaxation, emotion, expression and communication for people with all mental illness, including dementia [56]. In this way, art and music therapy can be used to treat symptoms and improve the experience for people. This could mean that creative therapies could help older people cope with the normal physiological changes which occur with ageing.
Please cite this article in press as: Price http://dx.doi.org/10.1016/j.maturitas.2014.05.025
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4. Some policy Implications of creativity for active ageing Over the last 20 years, theories of active ageing have been adopted into policy. The term active ageing was originally defined by the WHO [57] as “the process of optimising opportunities for health, participation and security in order to enhance quality of life as people age”. Active ageing is seen by the European Union (EU) as a key political model to lessen the impact of demographic change [58]. This policy framework aims to encourage activity in later life within a supportive social environment [57]. Therefore, as being active in later life has been politically encouraged so strongly, it is important to assess ways in which healthcare, social care, communities and families can provide opportunities for older people to remain active. European Union Guidelines on promoting active ageing in Europe, aim to accelerate the implementation of active ageing policies to ensure quality of life for older people is improving and will be sustained [59]. However the European Commission have subsequently stated that “In many countries, policies fostering active and healthy ageing have been rather modest and short of the necessary disease preventing and health promoting measures” [60]. Reasons might be that they are not appealing and mainly concentrate on physical activity. Creativity as part of active ageing is predominantly promoted by charitable organisations, but also by some local authorities. Age UK endorse the arts as part of the “leisure and learning” guidelines to encourage older people to access creative activities, promoting active ageing [61]. An example of local government implementing this policy is the Welsh Assembly Government and Welsh Arts Council publication “Arts in Health and Wellbeing: an Action Plan for Wales” which aids professionals in adapting the arts into healthcare and the community [62]. Although the positive impact of implementation in the field of active ageing is encouraging, policy specifically promoting creativity in old age is limited and mainly left to the voluntary sector.
5. Conclusion
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In the context of the ageing population, what it means to be “old” is changing. The older population is becoming increasingly diverse, with many retired people remaining active and contributing to society, whilst others suffer from deteriorating health and functional ability. Polices from the WHO, EU and British Government encourage older people to remain active in order to maintain health, well-being and ability well into later life. Creative activity is shown to play a role in maintaining mental and physical health, selfworth and social interaction [20]. Despite alterations in cognitive processing with age which decrease problem-solving ability and information retrieval, it can be argued that the older mind is more adept to imaginative thinking with increased distractibility and disinhibition. Studies in showing creativity across the lifespan even suggest that in later life, despite a decline in quantity of work by professional artists, the quality and accreditation of work increases with age. Therefore creative activity could provide older people with opportunity to develop new skills, achieve success and provide cognitive stimulation. The English Longitudinal Study of Ageing suggests that in the UK the number of activities people undertake outside the home declines with age [33]. Additionally, older people who are socially isolated, poor and have declining health status are the least likely to engage in activity [34], in spite of the fact that they may benefit the most. Therefore, even though creative activity is encouraged within policy and the number of opportunities available for creative activity outside the home is growing, the evidence suggests that many older people are unable to access these services. Therefore, future research is required to understand and develop Tinker
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programmes more appropriate and accessible for older people to reach them. The benefits of creative activity itself, ranging from visual arts to musical activity, have been explored extensively within the literature. The evidence reviewed here suggest that community based programmes encourage social integration, reduce stigmatisation, improve well-being, fitness and self-esteem. However, the provision of creative activities is not universal across UK. There is potential that the well and wealthy could access these opportunities for creative activity and those less able to access services will fail to benefit from them especially with an economic climate in which arts-based activities are not a priority. Nevertheless, if the knowledge that creative activity can benefit older people was more wide-spread, then all older people could endeavour to introduce a little creativity into later life, even through listening to the radio or engaging in creative session once in a while and experience the proven benefits. Creativity is even considered an evidence based treatment to improve self-esteem, promote achievement and develop social networks for those who are depressed or socially isolated. Moreover, within palliative care musical and arts based therapies can improve pain management and psychological well-being. Arts based therapies could be used as a conservative approach to help older people cope with the ageing process, as well as dealing with declining health and function which could potentially improve pain management in chronic conditions reducing the need for medication, reduce social isolation or depression and generally improve quality of life. These ideas could be explored in future research in order to provide alternative treatment for older people and reduce the need for expensive medical treatments. Overall, the literature presented suggests that creative activity could be a useful tool for individuals and society within the ageing population. However, further research is needed to establish the key factors in creative activities which contribute to patterns of improved health and well-being, as well as to explore ways to improve access to services and ways in which arts-based activities can be optimised to improve quality of life for older people.
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Price, K.A. holds the first authorship and the article was edited Q4 and supervised by Tinker, A.M. 442 441
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Competing interests None.
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