%0 Journal Article %J Aging & Mental Health %D 2023 %T Associations between participation in community arts groups and aspects of wellbeing in older adults in the United States: a propensity score matching analysis. %A Bone, Jessica K %A Fancourt, Daisy %A Fluharty, Meg E %A Paul, Elise %A Sonke, Jill K %A Bu, Feifei %K community groups %K Cultural engagement %K Epidemiology %K Mental Health %K music and arts %K Quality of Life %K Wellbeing %X

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.

%B Aging & Mental Health %V 27 %P 1163-1172 %G eng %N 6 %R 10.1080/13607863.2022.2068129 %0 Journal Article %J JAMA Netw Open %D 2023 %T Associations of Social, Cultural, and Community Engagement With Health Care Utilization in the US Health and Retirement Study. %A Gao, Qian %A Bone, Jessica K %A Bu, Feifei %A Paul, Elise %A Sonke, Jill K %A Fancourt, Daisy %K Aged %K Cohort Studies %K Delivery of Health Care %K Female %K Hospitalization %K Humans %K Male %K Middle Aged %K Patient Acceptance of Health Care %K Retirement %X

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.

%B JAMA Netw Open %V 6 %P e236636 %G eng %N 4 %R 10.1001/jamanetworkopen.2023.6636 %0 Journal Article %J Social Science & Medicine %D 2023 %T Receptive and participatory arts engagement and healthy aging: Longitudinal evidence from the Health and Retirement Study %A Rena, Melinda %A Fancourt, Daisy %A Bu, Feifei %A Paul, Elise %A Sonke, Jill K %A Bone, Jessica K %K Chronic disease %K Cognition %K cognitive impairment %K Cultural engagement %K Mental Health %K physical functioning %X 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’s lives for which they remain healthy ('healthspan’). 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. %B Social Science & Medicine %V 334 %P 116198 %G eng %R 10.1016/j.socscimed.2023.116198 %0 Journal Article %J Soc Sci Med %D 2023 %T Receptive and participatory arts engagement and subsequent healthy aging: Evidence from the Health and Retirement Study. %A Rena, Melinda %A Fancourt, Daisy %A Bu, Feifei %A Paul, Elise %A Sonke, Jill K %A Bone, Jessica K %K Chronic disease; Cognition; Cultural engagement; Mental health; Physical functioning %X

RATIONALE: Arts engagement is associated with prolonged longevity, but it remains unclear whether it is also associated with increases in the portion of people'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.

%B Soc Sci Med %V 334 %P 116198 %G eng %R 10.1016/j.socscimed.2023.116198 %0 Journal Article %J Social Science & Medicine %D 2022 %T Engagement in leisure activities and depression in older adults in the United States: Longitudinal evidence from the Health and Retirement Study. %A Jessica K Bone %A Feifei Bu %A Meg Fluharty %A Paul, Elise %A Jill Sonke %A Fancourt, Daisy %K Aging %K Creative activities %K depression %K Leisure %X

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.

%B Social Science & Medicine %V 294 %P 114703 %G eng %R 10.1016/j.socscimed.2022.114703 %0 Journal Article %J Social Science & Medicine %D 2022 %T Engagement in leisure activities and depression in older adults in the United States: Longitudinal evidence from the Health and Retirement Study %A Bone, Jessica %A Feifei Bu %A Meg Fluharty %A Paul, Elise %A Jill Sonke %A Fancourt, Daisy %K activities %K Arts %K depression %K Leisure %X 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. %B Social Science & Medicine %V 294 %P 114703 %G eng %R 10.1101/2021.04.15.21255495 %0 Journal Article %J PLoS One %D 2021 %T 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 %A Meg Fluharty %A Paul, Elise %A Jessica K Bone %A Feifei Bu %A Fancourt, Daisy %K Arts %K cross-sectional %K Culture %K health %K Well-being %X 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. %B PLoS One %V 16 %P e0261532 %G eng %N 12 %R 10.1371/journal.pone.0261532