%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 Generic %D 2023 %T Leisure engagement and self-perceptions of aging: Longitudinal analysis of concurrent and lagged relationships %A Bu, Feifei %A Mak, Hei Wan %A Bone, Jessica %A Gao, Qian %A Sonke, Jill %A Fancourt, Daisy %X 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’ 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' health. %G eng %R 10.31234/osf.io/qzjvb %0 Manuscript %D 2023 %T Leisure engagement in older age is related to objective and subjective experiences of aging %A Bone, Jessica K %A Bu, Feifei %A Sonke, Jill %A Fancourt, Daisy %X 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. %G eng %R 10.31234/osf.io/dh6f5 %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