@article {13858, title = {The reciprocal associations between social deficits, social engagement, and inflammation: Longitudinal evidence comparing venous blood samples and dried blood spots and mapping the modifying role of phenotypic and genotypic depression.}, journal = {Brain, Behavior, and Immunity}, volume = {119}, year = {Forthcoming}, pages = {120-128}, abstract = {

BACKGROUND: Social psychoneuroimmunology suggests an interplay between social deficits (loneliness and isolation) and chronic inflammation, but the direction of these relationships remains unclear. We estimated the reciprocal associations of social deficits and social engagement with levels of C-reactive protein (CRP), compared the consistency of the findings depending on the biological sampling method used, and examined the modifying role of phenotypic and genotypic depression.

METHODS: We used longitudinal nationally representative data from the US (Health and Retirement Study, 3 waves, 2006-16) and England (English Longitudinal Study of Ageing, 4 waves, 2004-18). Loneliness, social isolation, and social engagement were self-reported. CRP was measured using dried blood spots (US) and venous blood samples (England). Cross-lagged panel models were fitted and tested interactions with phenotypic depression (above-threshold depressive symptom scores) and genotypic depression (polygenic score for major depressive disorder).

RESULTS: We included 15,066 participants (mean age~=~66.1~years, SD~=~9.8) in the US and 10,290 (66.9~years, SD~=~10.5) in England. We found reciprocal associations between loneliness and CRP using dried blood spots and venous blood samples. Higher CRP predicted higher subsequent loneliness and higher loneliness predicted elevated CRP. Both phenotypic and genotypic depression modified this reciprocal association. There were also reciprocal associations for social engagement in venous blood samples: higher CRP predicted lower social engagement and greater social engagement predicted lower subsequent CRP. Associations between social isolation and CRP were inconsistent and unidirectional.

CONCLUSIONS: Loneliness may increase chronic inflammation, whereas social engagement may reduce inflammation. As these relationships were reciprocal, there may be a loop between inflammation, loneliness, and social engagement. This loop was stronger in those with depression or at high genetic risk for major depressive disorder. This relationship for loneliness was present in both blood sampling methods despite contrasting methods of CRP measurement, indicating that the finding is not attributable to measurement bias in biomarkers.

}, keywords = {chronic inflammation, depression, healthy aging, Social deficits, social engagement}, issn = {1090-2139}, doi = {10.1016/j.bbi.2024.03.045}, author = {Gao, Qian and Bone, Jessica K and Finn, Saoirse and Fancourt, Daisy} } @article {13796, title = {Longitudinal associations between loneliness, social isolation, and healthcare utilisation trajectories: a latent growth curve analysis.}, journal = {Social Psychiatry Psychiatric Epidemiology}, year = {2024}, abstract = {

PURPOSE: To explore the longitudinal associations between eight-year trajectories of loneliness, social isolation and healthcare utilisation (i.e. inpatient, outpatient, and nursing home care) in US older adults.

METHODS: The study used data from the Health and Retirement Study in 2006-2018, which included a nationally representative sample of American adults aged 50 and above (N = 6,832). We conducted latent growth curve models to assess the associations between trajectories of loneliness and isolation and healthcare utilisation over 8 years.

RESULTS: Independent of sociodemographic and health-related confounders, social deficits were associated with a lower likelihood of baseline physician visits (loneliness β= -0.15, SE = 0.08; social isolation β= -0.19, SE = 0.08), but there was a positive association between loneliness and number of physician visits (β = 0.06, SE = 0.03), while social isolation was associated with extended hospital (β = 0.07, SE = 0.04) and nursing home stays (β = 0.05, SE = 0.02). Longer nursing home stays also predicted better trajectories of loneliness and isolation over time.

CONCLUSION: Loneliness and social isolation are cross-sectionally related to complex patterns of different types of healthcare. There was no clear evidence that social deficits led to specific trajectories of healthcare utilisation, but nursing home stays may over time help provide social contact, supporting trajectories of isolation and potentially loneliness. Non-clinical services such as social prescribing could have the potential to address unmet social needs and further promote patients{\textquoteright} health-seeking profiles for improving healthcare equity.

}, keywords = {health inequity, Health service, healthy aging, Loneliness, social isolation}, issn = {1433-9285}, doi = {10.1007/s00127-024-02639-9}, author = {Gao, Qian and Mak, Hei Wan and Fancourt, Daisy} } @article {12387, title = {Associations between participation in community arts groups and aspects of~wellbeing in older adults in the United States: a propensity score matching analysis.}, journal = {Aging \& Mental Health}, volume = {27}, year = {2023}, pages = {1163-1172}, abstract = {

There is a social gradient in both arts engagement and wellbeing that may have led to an overestimation of the impact of arts engagement on wellbeing. We tested whether participation in community arts groups was associated with wellbeing after removing confounding by demographic, socioeconomic, and health-related factors. Using propensity score matching, we analyzed data from 12,055 older adults in the Health and Retirement Study. We measured community arts groups participation and concurrent life satisfaction (evaluative wellbeing), positive and negative affect (experienced wellbeing), and purpose in life, constraints on personal control, and mastery (eudaimonic wellbeing). After matching, arts group participation was associated with higher positive affect (average treatment effect on the treated [ATT] = 0.18, 95\% CI = 0.12-0.24), life satisfaction (ATT = 0.09, 95\% CI = 0.04-0.15), purpose in life (ATT = 0.07, 95\% CI = 0.02-0.13), and mastery (ATT = 0.07, 95\% CI = 0.01-0.14) than not participating. Participation was not associated with negative affect or constraints on personal control. In sensitivity analyses, these associations were maintained four years later. Arts group participation was associated with the positive elements of evaluative, experienced, and eudaimonic wellbeing. Facilitating participation in community arts groups could help to promote healthy aging, enabling a growing segment of the population to lead more fulfilling and satisfying lives.

}, keywords = {community groups, Cultural engagement, Epidemiology, Mental Health, music and arts, Quality of Life, Wellbeing}, issn = {1364-6915}, doi = {10.1080/13607863.2022.2068129}, author = {Bone, Jessica K and Fancourt, Daisy and Fluharty, Meg E and Paul, Elise and Sonke, Jill K and Bu, Feifei} } @article {13243, title = {Associations of Social, Cultural, and Community Engagement With Health Care Utilization in the US Health and Retirement Study.}, journal = {JAMA Netw Open}, volume = {6}, year = {2023}, pages = {e236636}, abstract = {

IMPORTANCE: There is growing evidence for the health benefits associated with social, cultural, and community engagement (SCCE), including for supporting healthy behaviors. However, health care utilization is an important health behavior that has not been investigated in association with SCCE.

OBJECTIVE: To examine the associations between SCCE and health care utilization.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study used data from the 2008 to 2016 waves of the Health and Retirement Study (HRS), a longitudinal panel study using a nationally representative sample of the US population aged 50 years and older. Participants were eligible if they reported SCCE and health care utilization in the relevant HRS waves. Data were analyzed from July to September 2022.

EXPOSURES: SCCE was measured with a 15-item Social Engagement scale (including community, cognitive, creative, or physical activities) at baseline (frequency) and longitudinally over 4 years (no, consistent, increased, or decreased engagement).

MAIN OUTCOMES AND MEASURES: Health care utilization was assessed in association with SCCE within 4 overarching categories: inpatient care (ie, hospital stays, hospital readmissions, length of hospital stays), outpatient care (ie, outpatient surgery, physician visits, number of physician visits), dental care (including dentures), and community health care (ie, home health care, nursing home stays, nights in a nursing home).

RESULTS: A total of 12 412 older adults (mean [SE] age, 65.0 [0.1] years; 6740 [54.3\%] women) were included in short-term analyses with 2 years of follow-up. Independent of confounders, more SCCE was associated with shorter hospital stays (incidence rate ratio [IRR], 0.75; 95\% CI, 0.58-0.98), greater odds of outpatient surgery (odds ratio [OR], 1.34; 95\% CI, 1.12-1.60) and dental care (OR, 1.73; 95\% CI, 1.46-2.05), and lower odds of home health care (OR, 0.75; 95\% CI, 0.57-0.99) and nursing home stays (OR, 0.46; 95\% CI, 0.29-0.71). Longitudinal analysis included 8635 older adults (mean [SE] age, 63.7 [0.1] years; 4784 [55.4\%] women) with data on health care utilization 6 years after baseline. Compared with consistent SCCE, reduced SCCE or consistent nonparticipation in SCCE was associated with more inpatient care utilization, such as hospital stays (decreased SCCE: IRR, 1.29; 95\% CI, 1.00-1.67; consistent nonparticipation: IRR, 1.32; 95\% CI, 1.04-1.68) but lower levels of subsequent outpatient care, such as physician visits (decreased SCCE: OR, 0.68; 95\% CI, 0.50-0.93; consistent nonparticipation: OR, 0.62; 95\% CI, 0.46-0.82) and dental care utilization (decreased SCCE: OR, 0.68; 95\% CI, 0.57-0.81; consistent nonparticipation: OR, 0.51; 95\% CI, 0.44-0.60).

CONCLUSIONS AND RELEVANCE: These findings suggest that more SCCE was associated with more dental and outpatient care utilization and reduced inpatient and community health care utilization. SCCE might be associated with shaping beneficial early and preventive health-seeking behaviors, facilitating health care decentralization and alleviating financial burden by optimizing health care utilization.

}, keywords = {Aged, Cohort Studies, Delivery of Health Care, Female, Hospitalization, Humans, Male, Middle Aged, Patient Acceptance of Health Care, Retirement}, issn = {2574-3805}, doi = {10.1001/jamanetworkopen.2023.6636}, author = {Gao, Qian and Bone, Jessica K and Bu, Feifei and Paul, Elise and Sonke, Jill K and Fancourt, Daisy} } @article {13542, title = {Hobby engagement and mental wellbeing among people aged 65 years and older in 16 countries.}, journal = {Nature Medicine}, volume = {29}, year = {2023}, pages = {2233-2240}, abstract = {

Growing aging populations pose a threat to global health because of the social and psychological challenges they experience. To mitigate this, many countries promote hobby engagement to support and improve mental health. Yet, it remains unclear whether there is consistency in benefits across different national settings. We harmonized measures of hobby engagement and multiple aspects of mental wellbeing across 16 nations represented in five longitudinal studies (N = 93,263). Prevalence of hobby engagement varied substantially across countries, from 51.0\% of Spanish respondents to 96.0\% of Danish respondents. Fixed effects models and multinational meta-analyses were applied to compare the longitudinal associations between hobbies and mental wellbeing. Independent of confounders, having a hobby was associated with fewer depressive symptoms (pooled coefficient = -0.10; 95\% confidence intervals (CI) = -0.13, -0.07), and higher levels of self-reported health (pooled coefficient = 0.06; 95\% CI = 0.03, 0.08), happiness (pooled coefficient = 0.09; 95\% CI = 0.06, 0.13) and life satisfaction (pooled coefficient = 0.10; 95\% CI = 0.08, 0.12). Further analyses suggested a temporal relationship. The strength of these associations, and prevalence of hobby engagement, were correlated with macrolevel factors such as life expectancy and national happiness levels but overall, little variance in findings was explained by country-level factors (<9\%). Given the relative universality of findings, ensuring equality in hobby engagement within and between countries should be a priority for promoting healthy aging.

}, keywords = {hobbies, Life Expectancy, Mental Health, Self Report}, issn = {1546-170X}, doi = {10.1038/s41591-023-02506-1}, author = {Mak, Hei Wan and Noguchi, Taiji and Bone, Jessica K and Wels, Jacques and Gao, Qian and Kondo, Katsunori and Saito, Tami and Fancourt, Daisy} } @booklet {unknown, title = {Leisure engagement and self-perceptions of aging: Longitudinal analysis of concurrent and lagged relationships}, year = {2023}, abstract = {Objectives: There is evidence to suggest that leisure engagement may influence self-perceptions of ageing, but disentangling potential bidirectionality in this relationship is challenging. A better understanding of the directionality of this association is essential for designing more effective interventions to promote healthy aging. We therefore tested both lagged and concurrent effects in both directions both for a composite measure of leisure engagement as well as specific domains of community, cognitive, creative, and physical activities. Method: A total of 17,753 adults aged 50 or above living in the United States from the Health and Retirement Study were included in the analysis. They provided 32,703 observations over three waves between 2008/2010 and 2016/2018. Data were analysed using structural equation modelling with both concurrent and lagged associations between self-perceptions of aging and leisure engagement, controlling for confounders including age, gender, ethnicity, socioeconomic position, and health conditions. Results: We found consistent evidence for leisure engagement as a predictor of self-perceptions of aging. There was weaker evidence for a reciprocal relationship, although this was found in the domains of creative activities and physical activities, where these two activities were also predicted by older adults{\textquoteright} self-perceptions of aging. Discussion: Our findings provide empirical support for potential benefits of leisure engagement on positive self-perceptions of aging, regardless of the type of activities. As the overall association appears to be stronger between leisure engagement and subsequent self-perceptions of aging, interventions designed to increase leisure engagement may be effective for improving older adults{\textquoteright} health.}, doi = {10.31234/osf.io/qzjvb}, author = {Bu, Feifei and Mak, Hei Wan and Bone, Jessica and Gao, Qian and Sonke, Jill and Fancourt, Daisy} } @article {bone_bu_sonke_fancourt_2023, title = {Leisure engagement in older age is related to objective and subjective experiences of aging}, year = {2023}, abstract = {Leisure engagement has potential to slow decline in older age and limit increasing healthcare costs as the number of older adults increases, but the potential benefits of different domains of leisure activities on aging experiences remains unclear. We included 8,893 older adults (mean age=63.18) from the Health and Retirement Study, a nationally representative study of individuals over the age of 50 in the US. Comparing four domains of leisure engagement (physical, creative, cognitive, and community activities), physical activity was most consistently associated with experiences of aging. It was related to more positive aging experiences concurrently in all seven domains (daily functioning, physical fitness, long-term physical health problems, heart health, weight, sleep, subjective perceptions of health) and was beneficially associated with all but one (heart health) of these domains eight years later. Engagement in creative activities was also positively related to experiences of aging in most domains concurrently, and daily functioning, physical fitness, sleep, and subjective perceptions of health longitudinally. However, cognitive and community activity engagement were less consistently related to aging experiences, particularly longitudinally. Looking across health domains, daily functioning, physical fitness, and subjective perceptions of health were most often associated with leisure engagement. Associations were independent of other domains of leisure engagement, demographic and socioeconomic factors, and previous experiences of aging. Our findings indicate that physical and creative activities may have a direct influence on important aging metrics, helping to reduce age-related decline, and keeping older adults functionally independent for longer. }, doi = {10.31234/osf.io/dh6f5}, author = {Bone, Jessica K and Bu, Feifei and Sonke, Jill and Fancourt, Daisy} } @article {12650, title = {Receptive and participatory arts engagement and healthy aging: Longitudinal evidence from the Health and Retirement Study}, journal = {Social Science \& Medicine}, volume = {334}, year = {2023}, pages = {116198}, abstract = {Background: There is increasing interest in the potential benefits of referring older adults to engage in community-based arts activities to enhance health. The arts have been found to have wide-ranging benefits for older adults including being associated with an increased lifespan. However, it remains unclear whether they are additionally associated with an increase in the portion of people{\textquoteright}s lives for which they remain healthy ({\textquoteright}healthspan{\textquoteright}). Methods: We included 1,269 older adults who completed the 2014 Arts and Culture Supplement of the Health and Retirement Study and were alive in 2016 and 2018. We measured the number of participatory arts activities engaged in (e.g., reading, crafts, dancing) and the frequency of receptive arts engagement (e.g., going to a gallery or performance) in the past year. Healthy aging was a binary outcome, conceptualized using a previously validated definition of no major chronic diseases, no cognitive impairment, good physical functioning, and good mental health. Logistic regression models tested whether receptive and participatory arts engagement were associated with healthy aging two and four years later. Results: After adjusting for demographic and socioeconomic covariates, doing receptive arts activities once a month or more was associated with 84\% higher odds of healthy aging two years later compared to never engaging (adjusted OR [AOR]=1.84, 95\% CI=1.06-3.19). There was some weak evidence that this association was maintained four years later (AOR=1.68, 95\% CI=0.97-2.90). Although doing one participatory arts activity was associated with 53\% lower odds of healthy aging four years later compared to no participation (AOR=0.47, 95\% CI=0.26-0.87), this association was not present at two years or for higher levels of participatory arts engagement. Conclusions: Expanding on previous studies, which have suggested that receptive arts engagement is related to prolonged longevity, our findings suggest that receptive arts engagement may also be associated with better overall health and function in those who survive. Those with poorer health may have been engaging in participatory arts because they were unable to attend receptive arts or broader leisure activities (indicating reverse causality), or receptive arts activities may contain specifically beneficial active ingredients for healthy aging. These possibilities present promising avenues for future research.}, keywords = {Chronic disease, Cognition, cognitive impairment, Cultural engagement, Mental Health, physical functioning}, doi = {10.1016/j.socscimed.2023.116198}, author = {Rena, Melinda and Fancourt, Daisy and Bu, Feifei and Paul, Elise and Sonke, Jill K and Bone, Jessica K} } @article {13521, title = {Receptive and participatory arts engagement and subsequent healthy aging: Evidence from the Health and Retirement Study.}, journal = {Soc Sci Med}, volume = {334}, year = {2023}, pages = {116198}, abstract = {

RATIONALE: Arts engagement is associated with prolonged longevity, but it remains unclear whether it is also associated with increases in the portion of people{\textquoteright}s lives for which they remain healthy. We investigated whether receptive and participatory arts engagement were associated with healthy aging two and four years later.

METHOD: We included 1269 older adults from the Health and Retirement Study (HRS), a longitudinal study of individuals aged 50 and above in the United States. Participants who completed the HRS 2014 Culture and the Arts Module and who were alive in 2016 and 2018 were eligible. We measured the number of participatory arts activities engaged in (e.g., crafts, dancing) and frequency of receptive arts engagement (e.g., going to a gallery or performance) in the past year. Healthy aging was a binary outcome, conceptualized as no major chronic diseases, no cognitive impairment, good physical functioning, and good mental health.

RESULTS: In logistic regression models, doing receptive arts once a month or more was associated with higher odds of healthy aging four years later compared to never engaging (odds ratio [OR]~=~1.80, 95\% CI~=~1.10, 2.96). However, this evidence was attenuated after adjusting for demographic and socioeconomic covariates (adjusted OR~=~1.44, 95\% CI~=~0.84, 2.46). The number of participatory arts activities engaged in was not associated with healthy aging two or four years later. In sensitivity analyses, there was some evidence that receptive engagement was associated specifically with higher odds of good physical functioning four years later.

CONCLUSIONS: The lack of consistent associations between receptive and participatory arts engagement and healthy aging was unexpected given previous evidence for links between arts engagement and each of the four domains of healthy aging. Our findings highlight key methodological issues that should be explored in further research with larger nationally representative samples, longer follow-ups, and more detailed measures of arts engagement.

}, keywords = {Chronic disease; Cognition; Cultural engagement; Mental health; Physical functioning}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2023.116198}, author = {Rena, Melinda and Fancourt, Daisy and Bu, Feifei and Paul, Elise and Sonke, Jill K and Bone, Jessica K} } @article {12105, title = {Engagement in leisure activities and depression in older adults in the United States: Longitudinal evidence from the Health and Retirement Study.}, journal = {Social Science \& Medicine}, volume = {294}, year = {2022}, pages = {114703}, abstract = {

BACKGROUND: Receptive cultural engagement (e.g. attending theaters and museums) can reduce depression in older adults. However, whether specific participatory leisure activities are associated with lower rates of depression remains unknown. We aimed to test whether engagement in a diverse range of leisure activities, all of which could involve artistic or creative elements, was associated with concurrent and subsequent depression.

METHODS: Using longitudinal data from 19,134 participants aged over 50 in the Health and Retirement Study, engagement in leisure activities was measured every four years, and depression every two years, between 2008 and 2016. Leisure activities included: reading books, magazines, or newspapers; writing; baking/cooking something special; making clothes, knitting, or embroidery (sewing); working on hobbies/projects; going to sport, social, or other clubs; and attending non-religious organization meetings. A score of three or more on the Center for Epidemiologic Studies Depression Scale indicated depression. We fitted population-averaged panel data models using generalized estimating equations with a logit link.

RESULTS: Engaging in some leisure activities, such as clubs, hobbies/projects, and baking/cooking was associated with reduced depression, independent of confounders. Concurrently, spending time on hobbies/projects (monthly OR~=~0.80, 95\% CI~=~0.72-0.88; weekly OR~=~0.81, 95\% CI~=~0.73-0.89) and clubs (monthly OR~=~0.85, 95\% CI~=~0.77-0.94; weekly OR~=~0.78, 95\% CI~=~0.69-0.88) was associated with lower odds of depression versus not engaging. Longitudinally, the odds of depression two years later were reduced amongst people engaging in weekly baking/cooking (OR~=~0.85, 95\% CI~=~0.75-0.95), hobbies (OR~=~0.81, 95\% CI~=~0.71-0.92), and clubs (OR~=~0.82, 95\% CI~=~0.71-0.94). Writing, reading, sewing, and attending non-religious organizations were not consistently associated with depression.

CONCLUSIONS: Engagement in some leisure activities is associated with reduced odds of depression. We should consider how older adults can be supported to actively participate in leisure activities as health-promoting behaviors.

}, keywords = {Aging, Creative activities, depression, Leisure}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2022.114703}, author = {Jessica K Bone and Feifei Bu and Meg Fluharty and Paul, Elise and Jill Sonke and Fancourt, Daisy} } @article {PPR:PPR314453, title = {Engagement in leisure activities and depression in older adults in the United States: Longitudinal evidence from the Health and Retirement Study}, journal = {Social Science \& Medicine}, volume = {294}, year = {2022}, pages = {114703}, abstract = {Objectives: Receptive cultural engagement, such as going to the theater and museums, has been shown to reduce depression in older adults. However, whether more active engagement in artistic and creative activities is associated with lower rates of depression remains unknown. We aimed to test whether active arts engagement was associated with concurrent and subsequent depression. Methods: Using longitudinal data from 19,134 participants aged over 50 in the Health and Retirement Study, arts engagement was measured every four years, and depression every two years, between 2008 and 2016. A score of three or more on the Center for Epidemiologic Studies Depression Scale indicated depression. We fitted population-averaged panel data models using generalized estimating equations with a logit link. Results: Engaging in artistic and creative activities, such as clubs, hobbies, and baking/cooking was associated with reduced depression, independent of confounders. Concurrently, spending time on hobbies (monthly OR=0.80, 95\% CI=0.72-0.88; weekly OR=0.81, 95\% CI=0.73-0.89) and clubs (monthly OR=0.85, 95\% CI=0.77-0.94; weekly OR=0.78, 95\% CI=0.69-0.88) was associated with lower odds of depression versus not engaging. Longitudinally, the odds of depression two years later were reduced amongst people engaging in weekly baking/cooking (OR=0.85, 95\% CI=0.75-0.95), hobbies (OR=0.81, 95\% CI=0.71-0.92), and clubs (OR=0.82, 95\% CI=0.71-0.94). Writing, reading, sewing, and attending non-religious organizations were not consistently associated with depression. Discussion: Active engagement in artistic and creative activities is associated with reduced odds of depression. We should consider how older adults can be supported to actively engage in the arts as a health-promoting behavior.}, keywords = {activities, Arts, depression, Leisure}, doi = {10.1101/2021.04.15.21255495}, author = {Bone, Jessica and Feifei Bu and Meg Fluharty and Paul, Elise and Jill Sonke and Fancourt, Daisy} } @article {11609, title = {Difference in predictors and barriers to arts and cultural engagement with age in the United States: A cross-sectional analysis using the Health and Retirement Study}, journal = {PLoS One}, volume = {16}, year = {2021}, pages = {e0261532}, abstract = {Introduction: Arts and cultural engagement are associated with a range of mental and physical health benefits, including promoting heathy aging and lower incidence of age-related disabilities such as slower cognitive decline and slower progression of frailty. This suggests arts engagement constitutes health-promoting behaviour in older age. However, there are no large-scale studies examining how the predictors of arts engagement vary with age. Methods: Data from the Health and Retirement Study (2014) were used to identify sociodemographic, life satisfaction, social, and arts appreciation predictors of (1) frequency of arts engagement, (2) cultural attendance, (3) difficulty participating in the arts, and (4) being an interested non-attendee of cultural events. Logistic regression models were stratified by age groups [50-59, 60-69, 70] for the frequency of arts participation outcome and [50-69 vs 70] all other outcomes. Results: Findings indicated a number of age-related predictors of frequent arts engagement, including gender, educational attainment, wealth, dissatisfaction with ageing, and instrumental activities of daily living (iADL). For cultural event attendance, lower interest in the arts predicted lack of engagement across age groups, whereas higher educational attainment and more frequent religious service attendance became predictors in older age groups (> 70). Adults in both age groups were less likely to report difficulties engaging in the arts if they had lower neighbourhood safety, whilst poor self-rated health and low arts appreciation also predicted reduced likelihood of this outcome, but only in the younger (50-69) age group. Adults in the older (> 70) age group were more likely to be interested non-attendees of cultural events if they had higher educational attainment and less likely if they lived in neighbourhoods with low levels of safety. Conclusions: Our results suggest that certain factors become stronger predictors of arts and cultural engagement and barriers to engagement as people age. Further, there appear to be socioeconomic inequalities in engagement that may increase in older ages, with arts activities overall more accessible as individuals age compared to cultural engagement due to additional financial barriers and transportation barriers. Ensuring that these activities are accessible to people of all ages will allow older adults to benefit from the range of health outcomes gained from arts and cultural engagement.}, keywords = {Arts, cross-sectional, Culture, health, Well-being}, doi = {10.1371/journal.pone.0261532}, author = {Meg Fluharty and Paul, Elise and Jessica K Bone and Feifei Bu and Fancourt, Daisy} }