Artful ageing In Singapore: exploring the health and wellbeing impact of arts and cultural heritage among older adults

• Main Author: Ma, Stephanie Hilary Xinyi
• Other Authors: Ho Hau Yan Andy
• Format: Thesis-Doctor of Philosophy
• Language: English
• Published: Nanyang Technological University 2024
• Subjects: Arts and Humanities; Medicine, Health and Life Sciences; Social Sciences; Older adults; Participatory arts interventions; Psycho-socio-spiritual wellbeing; Cultural heritage; Intergenerational relations; Psychological resilience; Singapore; Participatory action research; Systematic review; Qualitative; Mixed-method; Realist logic
• Online Access: https://hdl.handle.net/10356/180563
• Institution: Nanyang Technological University

Singapore is facing a rapidly ageing population with far-reaching implications to various domains such as the workforce, healthcare, and welfare systems, posing serious financial strains to the public budget. While increased longevity due to medical advancements is a positive development, concerns remain about the physical health, mental well-being, and overall fulfilment in old age. Consequently, promoting healthy ageing becomes imperative to enhance independence, self-sufficiency, and overall quality of life for older adults. Engagement in the arts could play a unique role in augmenting such health promotion strategies. The objective of this dissertation is to explore the impact of participatory arts engagement on the health and well-being of older adults. Specifically, this dissertation comprises of four distinct yet interconnected studies to provide a comprehensive exploration of the overarching objective from different angles. The first study involved the development of a broad understanding of current arts-based research for the health and wellbeing promotion of older adults via an overview of systematic reviews (Study 1), while the second study investigated the lived experience of arts engagement on holistic health among community-dwelling older adults in Singapore via a qualitative, constructivist focus group design (Study 2). Informed by findings from Study 1 and 2, the third study developed a novel intergenerational arts and heritage-based intervention established from a participatory action research approach and evaluated its efficacy via a wait-list randomised controlled trial (Study 3), and the fourth study identified potential mechanisms underlying the successful implementation and outcomes of the same intergenerational arts and heritage-based intervention via data collected from a five-arm randomised controlled trial (Study 4). Study 1 presented a systematic review of 84 systematic reviews and meta-analyses on creative arts interventions for older adults above the age of 60 [PROSPERO ID: CRD42020171979]. The study included various art forms and populations of older adults, and the outcomes consisted of a comprehensive list of health indicators (physical, psychological, social, quality of life, cognitive). The systematic reviews were evaluated using a modified AMSTAR 2 tool and majority were found to be of moderate quality. Among all art forms reviewed, music interventions and populations with cognitive impairments appeared to garner most research interest in the field. While most reviews suggested positive effects on cognition and wellbeing, the findings are mixed across studies due to heterogeneity in intervention and research methods. Common health-promoting mechanisms proposed include social connections, cognitive activation, and intrapersonal nurturance. The study also highlighted the need for rigorous methodologies, incorporating both quantitative and qualitative data, and clear reporting of interventions for understanding the impact of participatory arts engagement for older adults. These findings formed the basis for studies 2 – 4. Study 2 showcased the experiences of arts engagement among adults aged 60 and above in Singapore, along with insights from eldercare and arts service providers. Through 8 focus groups involving 75 participants from diverse backgrounds, various themes emerged. Using framework analysis, 35 themes emerged from the focus group discussions and were organized into seven interconnected major theme categories: Motivators to the Arts, Barriers to the Arts, Arts Engagement Processes, Benefits of the Arts, Community Enablers, Institutional Enablers and Societal Pillars. These themes collectively formed the Ecological Process Model for Sustainable Arts Engagement. This model provided insights into the impact of arts engagement, offered strategies for promoting and sustaining the arts within the community in Singapore, and guided the development of study 3. Study 3 reported the development and pilot testing of project ARTISAN (Aspiration and Resilience through Intergenerational Storytelling and Art-based Narratives), a 5-week, 15-hour intergenerational intervention [ClinicalTrials.gov ID: NCT03593967]. Building on the foundations of study 1 and 2, and utilizing a Participatory Action Research approach, the intervention was tailored to meet the needs of the community. The quantitative results demonstrated reduced loneliness, improved resilience, and enhanced quality of life. Qualitative findings highlighted ARTISAN's positive impact on psychological resilience, intergenerational bonds, and national identity, showcasing its multifaceted contributions. Study 4 employed a more in-depth approach to investigate the findings of study 3. It demonstrated the diverse benefits derived from different components of the ARTISAN intervention through a 5-arm RCT [ClinicalTrials.gov ID: NCT04548115]. While there were no statistically significant interaction effects for the between-group comparisons, the within-group quantitative analysis revealed that participation in the ARTISAN intervention increased civic engagement, while participatory arts engagement improved resilience and psychological wellbeing, and guided museum tours fostered cultural appreciation. Engagement in all conditions positively impacted quality of life except for participants in the storytelling condition. Qualitative narratives further revealed the unique contributions of artmaking in invoking creative expression and skill mastery, museum tours in promoting reminiscence and heritage appreciation, and intergenerational storytelling in fostering the exchange of life experiences and intergenerational inspiration. Integrating these components through the multimodal intervention framework of ARTISAN promoted well-being, social connectedness, challenged age stereotypes, and nurtured self-actualization in both age groups. The discussion section employed a realist logic to synthesize the findings from study 1 to 4. This approach allowed for a nuanced exploration of contextual factors and underlying mechanisms shaping the outcomes of the ARTISAN intervention. Eight Programme Theories (PTs) emerged which highlighted the importance of active arts participation, engagement within creative spaces, opportunities for life narrative expression, the integrative effects of intervention components, person-centred facilitation, well-structured curriculum design, motivated participant profiles, and strong collaboration with stakeholders in influencing the intervention's effectiveness. Harnessing the strength of different methodologies, this dissertation showcased the value of participatory arts as a valuable tool for promoting meaningful ageing among older adults. The results generated from this dissertation contributes to theory, research, and practice for the advancement of successful and healthy ageing in local, regional, and global communities.