| Abstract | 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. |
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