A non-medical way to improve elder care — art, imagination and creativity

Expressive practices can reduce loneliness and increase well being among seniors

“If you could look outside your window and see anything you wanted, what would you see?”

This was the question posed to a group of journalists by Anne Basting, a MacArthur Fellow and author of “Creative Care: A Revolutionary Approach to Dementia and Elder Care.” Many of us answered the question describing exactly what was outside our windows. But the question, as it turned out, was intended to be less literal.

Basting founded a company called TimeSlips, which helps the elderly reduce loneliness through creativity. She coined the phrase “creative care” to represent the two disparate realms of elder care: medical institutions with their heavy emphasis on managing the limits of the aging human body and mind; and the world of arts with its limitless possibilities for producing works of beauty.

These fields appear to have a hard separation and Basting began questioning this separation in her research. Older adults are framed tightly into the realm of health care, and almost always are referred to as “patients,” she said. “Their roles in life are limited. They are seen as users of service, burdens on the economy and as health care recipients of service.” And when it comes to the arts, seniors are often seen as “exceptions or aberrations.”

The potential of connecting elderly health care to creativity seems sort of obvious, but the way our care systems are structured to operate, there is actually very little of this in practice.

In 2019, my mother (then 87 years old showing signs of increasing cognitive impairment) used to spend at least two hours a day coloring in a book. Then she had a fall and broke her pelvis, and spent two months recovering in a nursing home in the Bay Area. A physical therapist was assigned to her and the emphasis was on teaching my mother how to walk and maneuver her walker. In those two months, she lost the habit of coloring and never managed to pick it up again, despite continuous efforts to persuade her. It was evident to me that while she had been engaged in the coloring activity, she had been more aware of the world around her.

Creative care changes the dynamics of care systems from being a service model to a co-creative model, infusing “meaning-making and beauty in everyday moments,” explained Basting.

Thinking of the well-being of the older population is imperative. Nationwide, there are 54 million people over the age of 65, representing 16% of the population.

According to the San Francisco Human Services Agency, 23% of San Franciscans were seniors in 2020, and by 2030 this population is predicted to grow to 27%.

A number of studies have shown the benefits of creative activity for seniors. In 2014, Penn State researchers Daniel R. George and Winona S. Houser interviewed 10 persons with dementia in a nursing care facility who participated in TimeSlips’ creative programs and found “increased creativity, improved quality of life, positively altered behavior, and involvement in meaningful activity for participants,” as well as benefits for caregivers and the nursing home community.

One of TimeSlips’ “meaningful engagement” programs implemented during the pandemic was Tele-Stories. A project that hires artists to perform storytelling sessions with older adults living alone in half-hour segments for a 12-week period. The starting point to these interactions is often a “beautiful question” like the one posed by Basting at the start of this article.

Robert Knapp, a 27-year-old musician, was one such artist. The question posed was about love. “I think love would be a cozy home,” was one response. Other responses included natural wonders like a rainbow and scenery. Knapp put music to the responses and performed a beautiful rendition of “Stand By Me” in a heartwarming YouTube audio recording.

Results of an evaluation done at the conclusion of the Tele-Stories project found that 51% of the participants felt less lonely and, interestingly, 65% of the artists, too, expressed a drop in loneliness.

I think of my mother. With her limited English skills, it seems she might fall through the gaps of this program as it is currently structured. Creative projects are tough to implement on a diverse older population with language and cultural differences; Justice in Aging reports that over 5 million older adults nationwide have limited English proficiency, like my mother.

Further, as Basting describes in her book, in a randomized control study of 12 senior center choirs by researcher Julene Johnson at UCSF, the results were mixed. The singers met for 90 minutes every week and gave public performances. However, while the choir members reported being less lonely and more interested in life, there were no measurable improvements in physical or cognitive health.

Despite these limitations, Basting’s ideas have considerable merit. Creative activity in a communal space makes meaningful connections. “It produces value for people who are seen as valueless,” she explained. Without these particular moments of connection, “We can be protected from infection but we won’t thrive. And that really was made very clear in the pandemic.”

“If I looked out my window I would like to see a very large garden of roses, of all different kinds of roses of different colors. And the reason I would like to see this is my husband was very good with roses. And each of the two homes that we had while he was alive had beautiful, beautiful rose gardens,” said Nancy in response to the “beautiful question” about what she’d like to see outside her window.

Jaya Padmanabhan is a journalist, author and director of programs at Ethnic Media Services. Twitter: @jayapadmanabhan. This article was written with the support of a journalism fellowship from The Gerontological Society of America, The Journalists Network on Generations and the Archstone Foundation.

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