Creative ageing: participation, connection & flourishing. A mixed-methods research study exploring experiences of participatory arts engagement in later life through a systematic review of literature and focus groups with older people

Background: A rapidly increasing ageing population has significant consequences for the demography, health and wellbeing of our society. Participatory arts programmes and activities can contribute to health promotion in later life, by providing community-based, non-clinical opportunities for meaningful engagement and interaction. To date, academic research studies have mainly focused on people living with dementia and have investigated the benefits of therapeutic and / or musical interventions. However, little research has been conducted with healthy older people participating in other arts’ domains such as the visual arts or been approached through a creative ageing lens. Creative ageing is an inherently interdisciplinary field of enquiry, which sits at the intersection of arts and health and social gerontology and places emphasis on the role of creative engagement in enhancing personal growth, creativity and building social connections in later life. Aims: This thesis uses a mixed-methods approach to explore experiences of participatory arts engagement in later life through a study of literature and focus-group conversations. The study considers existing theory within social gerontology, arts and health and the creative ageing movement in a conceptual review, providing the context that underpins the thesis. A mixed-methods systematic review is conducted to examine the published evidence on the effect of participatory arts on wellbeing, quality of life and cognitive function and to explore distinctions between engagement in different arts domains and levels of participation. A two stage focus group study aims to investigate whether themes developed from the review resonate with older people’s own subjective experiences of participatory arts engagement and to explore barriers to participation in the arts in later life. Methods: The study employs a multi-stance approach to data collection and analysis, through a mixed-methods methodology which draws on the traditions of pragmatism and phenomenography. First, a conceptual review explores key concepts in social gerontology, definitions of arts and health and approaches to ageing, including the burgeoning field of creative ageing, providing the theoretical context for the thesis. Next, a mixed-methods systematic review is conducted to identify relevant qualitative, quantitative and mixed-methods studies of the effect of participatory arts engagement in later life and older people’s subjective experiences of engagement. Quantitative results from studies in the review are analysed through an exploratory meta-analysis of the topic of subjective wellbeing and through narrative analysis, categorised by wellbeing and cognitive function domains for clarity. To employ creative methods in the analysis, as this is a study about arts engagement, qualitative findings are analysed using thematic and I-poem analysis, which places emphasis on the older people’s voice. The qualitative and quantitative analyses are then integrated to provide a combined evidence synthesis of experiences and effects of participatory arts engagement in later life. A two-stage focus group study is then carried out to explore whether the themes developed from the review resonated with participants’ own subjective experiences of participatory arts engagement and to explore barriers to participation. The first stage of the study involves three focus group sessions with groups of older people, which took place at three locations in Cambridge. Themes from the review were used as the stimulus for conversation and provide the structure for analysis. The findings are further scrutinised using Seligman’s (2011) PERMA model of wellbeing (Positive emotion, Engagement, Relationships, Meaning and Achievement) as a framework, focusing on the elements of wellbeing which contribute to a meaningful life. Stage two of the study examines barriers to participation with a more socioeconomically diverse sample of older people. This stage involves two additional focus groups which were held in Peterborough and Wisbech. Findings are re-analysed in light of the second study and identifies both barriers and facilitators to participation in the arts. Systematic reviews play an integral role in the production of research knowledge. However, review reports often remain in academia, without the findings being shared with relevant stakeholders. By further examining the systematic review findings through focus group interviews with older people, this thesis may help to close the gap between research and practice. Additionally, enabling groups of older people to discuss the findings meant that the study could be contextualised in contemporary group settings, increasing the quality and relevance of the review and reflecting participants’ voice. Concepts developed during the analysis are discussed in the final chapter and presented in a conceptual framework of creative ageing. Findings: The mixed-methods systematic review identified 33 relevant studies which investigated the effects of participation in dance, visual arts, creative writing and theatre on wellbeing, quality of life and / or cognitive function for healthy older people. Quantitative analysis produced as part of the systematic review process showed statistically significant improvements to some aspects of wellbeing following engagement in dance and visual arts activities, and enhanced cognitive function in the domains of general intellectual ability and attention after participation in different art forms. The exploratory meta-analysis showed an overall combined effect size of g=0.18 indicating the effect of dance on enhanced subjective wellbeing. Qualitative findings were developed into five themes: making and creating; connections and communities; identity; the ‘feel good’ factor; and body, mind & soul. Additionally, I-poem analysis revealed an association between positive emotion and participation in dance and a poem titled ‘I feel happy when I’m dancing’ was produced as a creative output. Findings from the review were shared in a two-stage focus group study. In the first stage of the focus group study, three supplementary themes were developed to those identified above: engagement as ritual; emotion and engagement; and ikigai. In stage two, an iteration of the theme of engagement as ritual was developed into spiritual resonance: engagement as ritual, along with a further theme around transitions of ageing. These themes elucidate the role of the arts and cultural engagement in supporting people to remain active and involved in their communities in later life and which may provide a ‘reason for being’. The study also allowed a connection to be made between the ritual of engagement in the arts and the sense of belonging felt by bringing people together creatively, in addition to the potentially detrimental effect of non-participation on subjective wellbeing. Transitions of ageing provides evidence for the role of creative engagement in challenging perceptions of ageing and enabling opportunities to explore a new sense of self in later life. In the second stage of the focus study, barriers to participation were categorised as: infrastructure, situational and dispositional barriers, as well as factors which might facilitate participation, classified as: intra-personal, inter-personal and external factors. Infrastructure barriers emphasised the need for accessible transport links which enable older people to access arts and cultural activities, particularly in more rural areas. Personal circumstances including finance and relationship status were highlighted as situational barriers preventing participation, while dispositional factors including low levels of selfefficacy and literacy may inhibit engagement. Findings also explicated factors which may provide solutions that improve access and inclusivity for older people wishing to participate in the arts, including offering taster sessions, befriending schemes and reducing financial and access restrictions. Finally, a conceptual model was developed which highlighted three key interwoven concepts of creative ageing: participation, connection and flourishing. Conclusions: This thesis substantiates existing evidence on the potential role of creative engagement in enhancing quality of life, promoting social connectedness and thus reducing loneliness in later life. It also contributes to the mixed-methods’ paradigm discourse through its innovative use of a creative method within the systematic review and the multiple-stance approach to the thesis. The study contributes new knowledge by establishing a meaningful association between creative ageing and human flourishing and provides evidence for the need for more accessible community-based arts activities which encourage older people to participate and develop positive connections. Factors which might inhibit or encourage participation should be considered in the design of creative programmes to ensure that they are accessible and inclusive to a diverse range of older people. In conclusion, creative engagement may contribute to developing more resilient, creative and healthier communities within which our ageing population are enabled to flourish. With an established evidence base on the benefits of participating in the performing arts, including dance for promoting subjective wellbeing, there is now an opportunity for us to expand our perceptions and understanding of creativity in later life through further research which embraces a broader definition of creative ageing.N/