Arts and Aging Building the Science

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    THEArTs

    And AGInGBuilding the Science

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    taBle o contentS

    liSt o acronymS.................................................................................................................................................................

    ExEcutivE Summary ......................................................................................................1

    Commo defciecie i the reeach....................................................................................................................................... 2

    Oppotuitie o Movig Fowa .............................................................................................................................................2

    Background ................................................................................................................... 3

    rESEarch and thE artSBridging thE gul ...................................................... 5

    Paticipatoy At o Ole Ault ..............................................................................................................................................5

    Muic, Heaig, a Memoy ........................................................................................................................................................6

    Muical Taiig a Bai Fuctio .........................................................................................................................................8

    Aeig Cogitive declie a demetia with the At................................................................................................ 8

    Muic Theapy o demetia ........................................................................................................................................................11

    Cot-Beeft Aalyi ......................................................................................................................................................................12

    Cot a Beeft o Eviece-Bae Pogam .................................................................................................................. 14

    Applyig Cot-Beeft Aalyi ..................................................................................................................................................16

    aESthEticS and dESign in group living arrangEmEntS ...............................18Theoetical Backgou o reeach i Viual At .............................................................................................................. 19

    deig o EveyoeIcluig Ole Ault .......................................................................................................................21

    rESEarch gapS and opportunitiES ..................................................................... 22

    reeach deig that Captue Log-Tem Eect o At o the Agig Poce .......................................................22

    Iteicipliay Team, Itegate At Itevetio, a Eate Appoache ..................................................23

    Theoie, Mechaim, Level o Aalyi, a replicable, rigoou deig .......................................................... 24

    Fuig Oppotuitie o Futue Wok .................................................................................................................................25

    Goig Fowa: Pomote Co-Talk a Take rik ..........................................................................................................25

    aPPendiX 1: WorkShoP ParticiPantS ........................................................................................................................26

    aPPendiX 2: commiSSioned PaPerS ............................................................................................................................ 27

    aPPendiX 3: WorkShoP agenda ..................................................................................................................................28

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    The ArTs And Aging: Building The science

    liSt o acronymS

    ad Azm aadcS Azm da coopatv sty

    artZ Att o Azm

    aBr atoy batm po to ompx o

    cBa ot-bft aay

    cE ot-tv

    EBd v-ba

    da u.s. Foo a d Amtato

    mri toa mat oa magap gop At Poam

    hhS u.s. dpatmt o hat a hma sv

    hrQl at-at qaty o

    iQ t qott

    ltc o-tm a

    mma Mm o Mo At

    naS natoa Aamy o s

    nccam natoa ct o compmtay a Atatv M

    nEa natoa eowmt o t At

    nia natoa ittt o A

    nih natoa ittt o hat

    oBSSr Of o Bavoa a soa s ra

    pa pya atvty

    pcori Patt-ct Otom ra ittt

    pd Pako a

    Qaly Qaty Ajt l Ya

    rct aomz oto ta

    Soc stv Optmzato wt compato

    ucla uvty o caoa, lo A

    Who Wo hat Oazato

    Wtp W to Pay

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    The ArTs And Aging: Building The science 1

    r

    ecet a ogoig eeach ugget

    excitig poibilitie o the theapeutic

    ue o at to impove the health a

    well-beig o ole ault. A thipopulatio gow i umbe a a a popotio

    o all Ameica, it will expeiece amatic

    iceae i the umbe o people with agig-elate

    health coitio, icluig cogitive eclie a

    emetia. Give the at potetial to teat, pevet,

    o amelioate thoe coitio, aitioal eeach

    i eee to claiy the elatiohip betwee the at

    a the health a well-beig o ole ault.

    A pat o a Feeal Iteagecy Tak Foce

    o the At a Huma developmet (www.nea.

    gov/news/news11/Task-Force-Announcement.

    html), the natioal Eowmet o the At (nEA)

    a thee uit withi the natioal Ititute o

    Health (nIH)the natioal Ititute o Agig

    (nIA), the Ofce o Behavioal a social sciece

    reeach (OBssr), a the natioal Cete

    o Complemetay a Alteative Meicie

    (nCCAM)joie i equetig the natioal

    Acaemy o sciece (nAs) to covee a public

    wokhop aou thi eeach ee. The nAs

    wokhop ubequetly aime to ietiy eeach

    gap a oppotuitie to ote geate ivetmet

    i pomiig at-elate eeach that ca ee

    itevetio to impove quality o lie o ole

    ault.

    so a, paticipatio i at itevetio ha

    bee like with impovig cogitive uctio a

    memoy, geeal el-eteem a well-beig, a well

    a eucig te a othe commo ymptom o

    emetia, uch a aggeio, agitatio, a apathy.

    some itevetio pomote ocial iteactio,which ha multiple pychoocial beeft.

    Muic i the mot commo paticipatoy at

    tuie, but theate, ace, a ceative witig alo

    hol pomie a eective health itevetio o

    ole people. Lielog muic taiig i aociate

    with may eect amog ole people, icluig

    impove memoy a heaig. Howeve, people

    who bega igig o othe muic activitie whe

    ole alo eive beeft i may aea, a i ole

    people who took actig clae o paticipate i

    ceative witig pogam o the ft time.

    deig a viual at play a impotat

    ole i the well-beig a quality o lie o ole

    people. The eig o eietial builig o

    ole people ca aect the amout a quality

    o ocial iteactio, phyical activity, cogitive

    timulatio, a emotioal well-beig o eiet.

    The lacapig, tafc ow, builig mateial,

    a eig o activity hub all cotibute to the

    ucce o ailue o a eietial acility a a thivig

    commuity.

    I aitio, the iceaig ue o uiveal

    eig ca help ole people paticipate moe ully

    i omal activitie. Uiveal eig embace

    the itegatio o place, thig, iomatio, a

    commuicatio to expa acceibility to the wiet

    pectum o ue i the wiet age o ituatio.

    eXecutive Summary

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    The ArTs And Aging: Building The science 3

    i

    Mach 2011, the natioal Eowmet o the

    At (nEA) a the U.s. depatmet o Health

    a Huma sevice (HHs) hote a ft-o-

    it-ki evet to howcae a icu eceteeach o the at a huma evelopmet, with

    the ultimate goal o fig way to egage the at

    to impove people live. The oe-ay oum

    examie the elatiohip betwee the at a

    poitive health a eucatioal outcome at

    vaiou egmet o the liepa a ecouage

    the omatio o a log-tem eeal patehip to

    pomote eeach a eviece-haig atiowie.

    It alo poite to the ee o a ytematic liteatue

    eview a gap aalyi to ietiy pioity aea o

    uthe eeach.1

    Builig o thee pomiig iitial eot,

    membe o a eeal takoce icluig the

    nEA a thee uit o the natioal Ititute o

    Health (nIH)the natioal Ititute o Agig

    (nIA), the Ofce o Behavioal a social sciece

    reeach (OBssr), a the natioal Cete

    o Complemetay a Alteative Meicie

    (nCCAM)equete that the natioal Acaemie

    (though it Committee o natioal statitic)

    covee a public wokhop to exploe way to

    tegthe eeach o the elatiohip o the at

    1The Arts and Human Development: Framing aNational Research Agenda for the Arts, Lifelong Learningand Individual Well-Being(2011), available atwww.arts.gov/research/TaskForce/Arts-and-Human-

    Development.html.

    a agig. The wokhop wa hel septembe 14,

    2012, i Wahigto, dC. The eciio to ocu o

    ole Ameicaa to ietiy eeach gap

    a oppotuitiei bae o a gowig iteeti ovel itevetio appoache o impovig the

    health a quality o lie o thi gowig populatio.

    I hi opeig emak, davi reube, a

    geiaticia, eeache, a eucato bae at

    the Uiveity o Calioia, Lo Agele (UCLA),

    a chai o the wokhop, ecibe ou o hi

    patietall atit o peomewho emai

    highly egage a pouctive well ito thei

    80 a 90. Wee thee patiet jut exceptioal

    iiviual, reube ake, o i thei lietime

    ivolvemet i the at help them avoi the cogitive

    eclie a othe apect o agig that o ote

    eoe ou health a quality o lie? To awe

    thee quetio, a ely le heavily o aecote,

    moe eviece i eee. specifcally, i thee a

    boy o cietifc eviece that emotate the

    ole o ceativity i the at i maitaiig health?

    Ca geate ivolvemet i the at by ole people

    euce the ue o meicie that ca have eiou

    ie eect?

    Paticipat om multiple icipliay

    viewpoit, icluig auitoy a cogitive

    euociece, geiatic, ocial wok, pychology,

    epiemiology, theate at, muic, achitectue, cot-

    eectivee a ecoomic, a health evice

    eeach, attee the septembe 2012 public

    wokhop to exploe topic elate to thee type o

    Background

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    4 The ArTs And Aging: Building The science

    quetio. (see Appeix 1 o lit o paticipat.)

    They ought to bette ueta i paticula:

    The elatiohip o at pogam a

    itevetio to pychological well-beig,

    cogitive, eoy, a moto kill uctio

    i ole ault, a the uelyig eual

    pocee;

    Beeft a weakee o at theapie

    compae with othe behavioal a/o ug

    itevetio o ole ault with ecliig

    cogitive, eoy, o moto uctio;

    Cot-eectivee aalyi o uch pogam

    compae with othe healthcae itevetio

    o thi populatio; a

    The elatiohip o aethetic a eig actoto health a quality-o-lie-elate outcome o

    ole ault i log-tem cae a aite livig

    acilitie.

    Five pape wee commiioe o peetatio at

    the wokhop to ote cocete icuio about

    eeach gap a oppotuitie o exploig

    the elatiohip o at paticipatio to phyical

    health a pychological well-beig i ole ault

    (Appeix 2). Thee pape ae beig pepaeo publicatio a ae ot ummaize hee. A a

    collectio, the pape a peetatio eiche

    the wokhop icuio about the challege o

    builig eeach capacity. They oe guiace o

    the eig o utue tuie a eeach.

    repeetative o eeal uig agecie that

    co-pooe the wokhop coiee it impotat

    o avacig thei vital iteet i ehacig health

    o ole Ameica o multiple level, icluig

    evelopig eective health itevetio, ceatig

    ew tategie to ehace ocial ivolvemet a

    uppot amog ole ault, a iceaig the

    awaee a pomotig the aoptio o eective

    health itevetio. Maie A. Bea, eputy

    iecto o the nIA, emphaize the type o eeach

    o paticula iteet to the nIA, icluig:

    Icopoatig at activitie i itevetio to

    emeiate o elay age-elate cogitive eclie

    o eoimoto impaimet;

    Examiig the potetial o pecifc at activitie

    a itevetio to ehace quality o lie i

    ole ault i ieet eietial ettig a

    with ieet health tatue;

    Examiig the potetial o at itevetio

    to uppot healthy commuitie a ecouage

    ocial egagemet aco geeatio; a

    Uetaig the potetial impact o the at

    o othe health outcome.

    rocco Laema, the-chaima o the nEA,

    ecibe the nEA eot to peuae eealagecie to pomote the impotace o the at i

    othe ecto a it cotiue eot to geeate

    geate uppot o a ackowlegemet o the

    at. suil Iyega, iecto o the nEA Ofce o

    reeach & Aalyi, uge the ogaize, peake,

    a paticipat to coie thee oveachig iue:

    Ae thee theoetical moel that explai how

    paticipatio i the at aect the health a

    well-beig o ole Ameica?

    How ca we bet meaue the eect o at

    paticipatio o ele health, give the complex

    web o vaiable at wok? I paticula, ae thee

    iovative tuy eig that coul be ue i

    lieu o raomize Cotolle Tial (rCT)?

    How ca we buil eeach capacity i thi aea?

    Ca we utue a cae o eeache who ca

    take thi eeach to the ext level a who ca

    attact the uppot o potetial ue?

    The emaie o thi epot highlight omiat

    theme expee at the wokhop a ietife

    efciecie i cuet eeach a oppotuitie o

    movig owa. The wokhop agea i iclue

    a Appeix 3.

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    The ArTs And Aging: Building The science 5

    i

    volvemet with the at ca aect people o

    may phyical, cogitive, a emotioal level,

    ceatig eect that ae ifcult to captue uig

    taa eeach eig. Cultual ieecebetwee atit a eeache alo ca make it ha

    to pouce what the cietifc eeach commuity

    woul ecibe a cietifcally igoou eeach.

    noice, noice, a Kame (2012) have epote

    that thei each o the liteatue eveal a paucity

    o eeach o the eect o at paticipatio a

    phyical, cogitive, a pychological well-beig,

    poibly becaue atit te to have a miet that

    eit quatifcatio a eeache ae geeally

    ucomotable with vagaie.2 A Toy noice

    metioe, atit ae moe likely to ay, Let o

    omethig a ee what happe.

    Wie ue o eective theapeutic at pogam

    coul ehace the health a well-beig o ole

    Ameica. The cietifc commuity expect

    cietifc eviece ot oly to emotate that

    itevetio ae eective but alo to povie baic

    iomatio about the equecy a iteity

    equie (oe), the uatio o a eect, a

    whethe the at itevetio wok at leat a well

    a othe health itevetio.

    2 noice T., noice H., a Kame A. 2012. PaticipatoyAt o Ole Ault: Beeft a Challege. Papepepae o the Wokhop o reeach Gap aOppotuitie o Exploig the relatiohip o the At toHealth a Well-Beig i Ole Ault, natioal Acaemyo sciece, Wahigto, dC, septembe 14, p.3.

    The aemet o exitig eeach by the

    wokhop peete ietife a umbe o commo

    efciecie i at itevetio eeach, icluig:

    Pooly efe, oaom, a mall ample.

    Iaequate cotol goup.

    Pooly efe o iaequately ocumete

    at itevetio, epecially with ega to the

    equecy a iteity o the activity (the oe),

    makig fig ifcult to eplicate.

    Icoitet health outcome aco tuie a

    lack o commo tool o meauemet.

    Weak tatitical methoology, epecially

    give attitio o miig ata, a ovetatecocluio.

    participatory artSor oldEr adultS

    Wokhop paticipat Toy a Helga noice

    exploe the elatiohip betwee paticipatoy at

    a the cogitive/phyical health a pychological

    well-beig o ole ault. They peete ome

    compellig tuie howig how ole paticipatbeefte om a vaiety o at (ace, muic,

    pottey, viual at, a expeive witig).

    Toy noice, a poeioal acto a eucato,

    emotate how actig clae he couct with

    ole paticipat compel cogitive, emotioal, a

    phyical actio. Actig alo egee tog ocial

    reSearch and the artSBridging the gul

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    6 The ArTs And Aging: Building The science

    uppot, a valuable aet o ole people.

    To quatiy how actig aect ole people, the

    noice aomly aige 122 eligible volutee

    om etiemet home to a actig, igig,

    o waitig-lit cotol goup. Ate a ou-week

    iteive coue, the acto impove igifcatlyo eve o eight cogitive meaue, moe tha the

    ige o cotol goup. Both the acto a ige

    impove o el-epot o peoal gowth, a

    meaue by a taa quality o lie meaue. The

    cotol goup i ot how the ame impovemet.3

    A theate taiig pogam ow i poge

    ha ae euoimagig [MrI] to captue

    poible chage i bai uctio elate to active

    paticipatio i theate. Kame ecibe how

    euoimagig ha bee ue to augmet cogitivea pychoocial meaue a to eveal chage

    i bai uctio i ivee itevetio, icluig

    execie a well a volutee activity.

    Kame epote that he i wokig o a nIA-

    uppote tuy cotatig balloom acig with

    walkig, toig, tegtheig, a tetchig o

    multiple pychoocial, behavioal, a euoimagig

    meaue peviouly ue i walkig tuie. dace

    i tuly multimoal, which ca complicate evaluatig

    it eect uig taa eeach eig.

    repoig to quetio om the auiece, Toy

    noice emphaize the beeft o the multimoal

    apect o actig: It ivolve the mi, boy, a

    emotio. Ulike playig a itumet, actig oe

    ot equie peviou taiig, o eve iitial iteet.

    Paticipat i 15 yea o hi actig clae impove

    o the outcome tete eve though they wee

    aomly aige to the actig veu igig cla.

    3 stuy paticipat wee ceee uig the Peie shotPotable Metal statu Quetioaie to eue theyha itact itellectual uctioig. The eight cogitivemeaue wee: Wo Lit Memoy, Wo Lit delayerecall, Categoy Fluecy, digit spa Fowa, digitspa Backwa, Eat Boto Memoy Tet, Eat BotoMemoy Tet elaye, Mea-E Poblem solvig. Iaitio, oe Quality o Lie scale wa amiitee: selrepote Peoal Gowth.

    muSic, hEaring, and mEmory

    nia Kau peete eeach o muic taiig

    a agig. Oe o the mot commo complait o

    a ole ault, Kau ote, i uetaig peech

    whe thee i backgou oie. Aothe commo

    poblem i the eclie o auitoy wokig memoy

    with age. The eviece i eouig that, aco

    the lie pa, muical taiig a paticipatio

    ca be a emey o both poblem, a emotate

    by taaize tet o heaig i oie a o

    wokig memoy.

    How oe muic taiig help? With ega

    to heaig, Kau ote that muicia ae goo

    at extactig elevat iomatio om a complex

    oucape a that thi ability talate to a

    geate acility with heaig peech i oie i ole

    age, eve a heaig eclie.

    Muic peomace equie memoy. To lea,

    ea, a peom muic, muicia mut memoize

    ou a viual patte; memoize auitoy-moto

    equece; tue a itumet; a impovieall

    activitie that execie memoy.

    To bette ueta how muic taiig

    aect cogitive activity, Kau a he colleague

    examie bai activity i ole people with a

    without muic taiig. They wee iteete i thelowig o eual activity that occu with agig.

    Thi lowig i aociate with eceae ihibitio,

    boae eual tuig, loge eual ecovey, a

    a iceae i eual backgou oie. Kau a

    colleague applie a biological appoach calle

    auitoy baitem epoe to complex ou

    (cABr), which ue a ew calp electoe to

    captue the electical activity o euo i the bai

    ue pecifc ituatio. The eual epoe to

    ou come lagely om the mibai, the ite ocovegece o iomatio comig om the ea

    a ivolvig emotioal aea: executive uctio,

    attetio, a memoy. The mibai play a citical

    ole i auitoy leaig. Kau a he colleague

    examie eeback to the auitoy ytem om bai

    egio epoible o executive uctio.

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    The ArTs And Aging: Building The science 7

    The cABr techique i a eective a

    poweul way to tuy bai activity elate to

    commuicatio/ou, a well a how the bai

    i chage by expeieceo example, muical

    taiig. Kau eviio cABr aaptatio om

    laboatoy ue to a much wie ue i the feli etiemet home, o example, uig a heaba

    a iPa. The cABr eeach emotate the

    eect o agig o timig, hamoic magitue,

    ychoy (phaelockig), coitecy, a

    eual oie.

    Kau cite the commo ifculty o

    itiguihig bill om pill, amog ole people.

    The iitial lettea api, complex oui the

    ouce o the ifculty i uetaig. The cABr

    eult howe that epoe euo eact moelowly amog ole ubject, which mea that it

    take lightly loge o ole people to ueta

    the ou they have jut hea. The fig i

    coitet with thoe om aimal tuie. The

    evou ytem oe ot low o all ou, but

    oe o ha, complex ou. Kau a he

    colleague alo ou le coitecy i the eual

    epoe to the epetitio o the ame ou i a

    ole tha i a youge bai.

    The evou ytem i goo at accuately

    epoig to the ou equecie that make up

    muic a peech, but thi capacity imiihe a

    people age. I aitio, the peceptio o backgou

    oie iceae with agig. Thee two acto may

    copie to make heaig moe ifcult a we age.

    Kau eeach with cABr how that

    muicia weathe thee agig eect bette tha

    omuicia. she ou that muicia bai

    ae quicke to epo to ou a that ole

    muicia ca itiguih ou moe coitetly

    a ueta peech i backgou oie bette

    tha ole omuicia.4 He fig ugget that a

    lietime o makig muic pomote impove heaig

    i oie, auitoy memoy, a biological poceig

    4 I thi tuy, active muicia pactice 20 miute aay, thee time a week.

    o ou. Paticipatio alo ehace commuicatio

    kill, cogitive uctio, a phyical health.

    rs gps Qss

    Kau ote that, while thi eeach ugget

    umeou beeft om paticipatio i muic, the

    equecy o iteity o paticipatio equie to

    gai thee beeft emai ucetai. Thee ae

    may potetial eeach quetio: do the beefcial

    eect iipate i people abao thei muic o

    igifcatly euce thei pactice time? I o, how

    log oe thi poce take? Ca they egai the

    beeft i thei ole age i they etu to muic?

    do people who take up muic o the ft time at

    ole age alo eap beeft?

    Kau ee clue to the awe to theequetio i two aveue o eeach: hot-tem

    muic taiig amog chile a otwae-bae

    taiig with ole ault. He eeach how that

    chile eceivig muic taiig impove thei

    eaig a vebal IQ moe tha thoe eceivig

    at taiig, o with eithe type o taiig. Kau

    aete that thi cooboate othe eeach

    howig a paticulaly tog cogitive beeft

    o muic, uggetig that muic might opeate

    ieetly tha othe paticipatoy at.reeach with ole ault ha emotate

    that otwae-bae taiig ca mimic the cogitive

    beeft o muic taiig. A cuet tuy o a

    auitoy- a memoy-bae bai fte pogam

    put out by Poit sciece ou that heaig i oie

    impove ate a iteive taiig pogam.5 Kau

    alo ou gai i the auitoy wokig memoy o

    tuy paticipat, compae with a cotol goup.

    she ee thee fig a coitet with eviece

    that the ole evou ytem i malleable a

    capable o poitive chage.

    I epoe to quetio om the auiece,

    Kau tee the act that he eeach ivolve

    people who ae actively playig a itumet.

    5 The paticipat taie o the otwae 40 miute aay, fve ay a week o two moth.

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    8 The ArTs And Aging: Building The science

    Mot o he ata petai to itumetalit a

    the itumet ue oe make a ieece. The

    evou ytem epo to the ou o the pecifc

    itumet playe. cABr eult howe that

    bai epoe wee geate o people playig

    the baoo tha thoe playig piao, o example.A iteetigly, the evou ytem o taie

    muicia epo to thee apect o ou

    whethe they ae awake o aleep.

    Kau ha a cuet tuy compaig vocalit

    a umme, which peet challege whe

    cotuctig a cotol goup becaue ige caot

    pactice a may hou a people who play othe

    itumet. Yet, igig ivolve the etie boy,

    o it i moe itee i ome way. How much

    people pacticewhethe they play aloe o ieembleall make a ieece a waat

    aitioal eeach.

    muSical trainingand Brain unction

    Gottie schlaug, who i both a euocietit

    a ogait, alo peete iomatio about the

    elatiohip betwee muical taiig a bai

    uctio. He wa aw to the topic becaue o a

    peoal iteet i the euociece o peect pitch.schlaug compae the bai activity o people

    who ae active muicia with paive litee.

    Muicia, he ai, ae auitoy-moto athlete.

    Thei bai have a igifcatly lage copu

    colloum tha omuicia, paticulaly the iteio

    two-thi o that egio. He ou vaiatio

    accoig to the iteity o muical taiig a

    by the type o itumet, peumably eectig

    the ieet moto a auitoy kill equie. He

    a colleague tuie the 3d cofguatio o thepecetal gyuite o the pimay moto cotex

    amog tig playe a keyboa playe. stig

    playe ha a moe elaboate ight moto cotex

    cotollig the let ha, while the keyboa playe

    ha a moe elaboate moto cotex o both ie o

    the bai.

    He peete vieo eviece o the theapeutic

    ue o muic with people ecoveig om a bai

    ijuy. A toke victim who coul ot ay I am

    thity i compeheible peech coul ig the

    ame wo with peect claity. schlaug ecibe

    how epeate taiig coul eable ome patiet toegai the ability to peak the wo.

    Muic alo ehace movemet i people

    with Pakio ieae (Pd). schlaug howe

    a vieo epictig how the gait a exibility

    o a Pd patiet amatically impove whe

    muic wa playe. similaly, noice, noice, a

    Kame (2012) epote that Pd patiet howe

    amatic impovemet i exibility a movemet

    ate paticipatig i balloom acig clae.

    reeache o ot ueta why a impaiebai ca eact o togly to muic. The eviece

    how that muic ca have emakable theapeutic

    eect i ome itace.

    addrESSing cognitivE dEclinEand dEmEntia With thE artS

    The umbe o Ameica with Alzheime ieae

    (Ad) will moe tha ouble betwee 2010 a 2050,

    om 5.1 millio to 13.2 millio. The iect cot o

    thei cae will oa om $172 billio to $1.1 tillioove that peio.6 Thee ae o phamaceutical

    cuetly available that halt the ieae, jut fve

    FdA-appove ug that tempoaily impove

    ymptom. But fig way to elay the ebilitatig

    eect o Ad woul igifcatly euce the cot o

    cae.7 Thi make the theapeutic ue o at o ole

    6 see Figue 4 a page 48 i Alzheime Aociatio,2012 Alzheime dieae Fact a Figue.Alzheimersand Dementia: The Journal of the Alzheimers Association.Mach 2012; 8:131-168 a Alzheime Aociatio, 2010

    Alzheime dieae Fact a Figue, both available atwww.alz.org.7 The 2012 Alzheime dieae Fact a Figue ote:Becaue o the iceae cot a lo o iepeeceaociate with placemet i a uig home, tategieto pevet o elay uig home placemet ae eiable.It ha bee etimate that elayig log-tem cae by oemoth o each peo i the Uite state age 65 o olecoul ave $60 billio each yea.

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    The ArTs And Aging: Building The science 9

    emetia patiet a impotat iue o eeach

    om a public health pepective.

    Ae Batig a Kate e Meeio aee

    the boy o cietifc eviece elate to at a

    othe type o itevetio o cogitive eclie,

    euopychiatic ymptomuch a agitatioo ight waeiga quality o lie i people

    with emetia.

    Batig a e Meeio examie ytematic

    eview o eeach o thee type o itevetio:

    phamacological, ophamacological (excluig

    the at), a at pogam. Thee wee ealy

    2,900 tuie publihe o thee topic ice 2000,

    but ew at itevetio tuie wee iclue i

    ytematic eview, ote becaue they i ot meet

    eviewe baic citeia o a aomize eiga aequate cotol. A tate by othe wokhop

    peete, at itevetio ae ifcult to

    tuy i a rCT, which i coiee the gol

    taa o cliical tial eige to tet a

    itevetio efcacy o eectivee. At

    itevetio ivolve multiple elemet that ca

    iuece behavio, icluig ocial iteactio,

    peoal iteet, a the quality o ituctio o

    elivey mechaim.

    de Meeio alo poite out that tet

    geeally ue i rCT ivolvig cogitio a

    behavio wee evelope o phamacological

    tuie a tagete o the legth o time eceay

    o a ug to take eect. such tet o ot captue the

    immeiate impact o a at itevetio o moo

    o apathy. Futhe, ome commo tet, uch a the

    neuophychiatic Ivetoy, meaue behavio

    uch a eluio a halluciatio, which ae

    ulikely to be aecte by a at itevetio. Thi

    make it ifcult to compae eult betwee at

    itevetio a phamacological itevetio.

    Give the poblem fttig at itevetio

    tuie ito the taa rCT eig, Batig a

    e Meeio expae thei aemet to iclue

    itegative eview o tuie, which coie

    moe qualitative apect o eeach. Becaue

    phamacological itevetio wee well covee i

    the ytematic eview, the autho exclue them

    om the itegative eview.

    Batig a e Meeio aemet o

    phamacological itevetio ou that the

    ug doepezil howe mot pomie o lowig

    cogitive eclie, epecially whe combie withcogitive timulatio. But thi a the othe ug

    tuie have igifcat ie eect, which ca

    outweigh thei theapeutic beeft o patiet with

    Ad. They ote that jut fve ug ae appove by

    the Foo a dug Amiitatio (FdA) o ue

    i Ad patiet. All how limite eectivee a

    egative ie eect.

    nophamacological itevetio eviewe

    iclue behavio maagemet a moifcatio,

    cogitive timulatio (though icuio oactivitie), chagig the phyical eviomete.g.,

    emovig mio o iguiig oowayemotio-

    oiete cae, a imulate peecee.g., though

    vieo o amily membe.8

    The at itevetio iclue i the ytematic

    o itegative eview pimaily ivolve muic,

    which might age om paive liteig to muic

    (to calm patiet) o active um cicle paticipatio.

    The tuie i ot ae cogitive eclie

    but eveal epote impove euopychiatic

    ymptom, uch a euce aggeive o agitate

    behavio. seveal muic itevetio impove

    patiet epote quality o lie, a i ome tuie

    o itevetio ivolvig ama a paticipatoy

    at-makig.

    I geeal, the eview ou pomiig eult

    om ophamacological itevetio, but the

    tuie wee aulte o thei weak tuy eig.

    The ample tee to be quite mall (117 patiet

    o ewe) a the meaue outcome wee ot

    compaable aco tuie.

    The tuie tete o ieet type o

    outcome, but the eult oveall howe ome

    8 Othe itevetio iclue eality oietatio,emiicece, eoy timulatio, valiatio theapy, aTAP (Tailoe Activity Pogam).

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    10 The ArTs And Aging: Building The science

    beeft to cogitio. seveal itevetio i aect

    euopychiatic ymptomeucig agitatio o

    ight waeig, o examplebut ecoe little o

    o iceible eect o quality o lie.

    Becaue at-bae itevetio ae

    multimoal, multilevel, a may pouce ubtlechage, they ae ifcult to evaluate a rCT.

    May meauemet tool cuetly beig

    ue caot captue the tue o ull impact o

    multimoal itevetio. Batig a e Meeio

    ecommee ietiyig a evelopig alteative

    appoache to at itevetio eeach. rathe tha

    ocuig o a peee itevetio, uch a muic,

    ace, o theate, they uggete that eeache

    ue a itegative appoach that combie thee

    activitie a buil i impoviatio, expaig themultimoal apect o paticipatoy at.

    They uthe ecommee eachig o the

    mechaim that lea to cogitive o othe chage

    to ueta how a itevetio might aect

    cogitio a behavio: What ee ae egage

    a how? I the itevetio paticipatoy? doe

    it acilitate cogitive uctio o ocial iteactio?

    They uecoe the ee o moe etail about

    a itevetio to ietiy thoe mechaim a

    to elect appopiate meauemet tool. such

    iomatio will claiy who ca povie the pogam

    (caegive o taie poeioal) a eich

    coveatio betwee theapit a atit. Alo,

    eeache ee to evelop itevetio tailoe

    o a iiviual ituatio.

    Fiig appopiate tool o evaluatig at

    itevetio i cucial. de Meeio ai the

    ft tep woul be to etemie which behavio

    o uctio (e.g., apathy, iitability, ocial

    coectee, appetite) woul be poitively aecte

    by at-bae itevetio a ove what time

    peio (e.g., oe hou, oe ay, oe week, etc., ate

    the itevetio). she ai that tet that ca captue

    immeiate a log-tem epoe make the mot

    ee o evaluatig a at-bae itevetio.

    The Obeve Emotio ratig scale i oe optio.9

    Although a extemely bie cale, it povie a

    way to eco the appeaace o pleaue, age,

    axiety, ae, o geeal alete i fve-

    miute iteval. Othe poible tet iclue

    moitoig chage i oo coumptio, the ApathyEvaluatio scale, a a moe etaile veio o the

    neuopychiatic Ivetoy.

    Batig a e Meeio uggete that

    eeache a atit woul o well, moeove,

    to ocu o the impact o itevetio beyo

    the iiviual. Atitic pouct ca ceate ocial

    capital o peo with emetia by oteig cloe

    coectio amog patiet, cae pate, ie,

    a amily.

    I epoe to auiece quetio, Batigecibe the wie impact o the Timeslip

    pogam, which ivolve impoviatioal toytellig

    with emetia patiet. The Timeslip pogam

    ecouage people with emetia to expe

    themelve though goup-geeate toie,

    a ailig memoie i ot ete thei ceative

    toytellig. Ate te week i the pogam,

    paticipat i log-tem cae acilitie with the

    Timeslip pogam wee moe egage a alet.

    The pogam ca be amiitee by taie

    uig home ta; oe o the upiig beeft

    ha bee impove elatiohip amog the ta

    a eiet. sta i Timeslip acilitie epote

    moe equet ta-eiet iteactio a a

    moe poitive view o thei patiet tha ta i the

    cotol acilitie with o pogam.10

    9 Lawto, M., Va Haitma, K., Klappe, J. 1999. ObeveEmotio ratig scale, available at www.abramsoncenter.org/pri/documents/observedemotion.pdf.10

    Fitch, T., et al. 2009. Impact o Timeslip, a CeativeExpeio Itevetio Pogam o nuig Homereiet with demetia a Thei Caegive. TheGeronologist 49(1): 117-127; Philip, L., s.A rei-At,a Y. Pak. 2010. Eect o a Ceative ExpeioItevetio o Emotio, Commuicatio, a Qualityo Lie i Peo with demetia,Nursing Research59(6): 417-425. summaize i The Arts and Human

    Development: Framing a National Research Agenda for theArts, Lifelong Learning and Individual Well-Being(2011),available at www.arts.gov/research/TaskForce/Arts-and-

    Human-Development.html.

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    The ArTs And Aging: Building The science 11

    she uge eeache to imagie itevetio

    that ca egage people outie cogegate cae

    ettig. Mot itevetio ivolve people livig i

    goup ettig, yet they ae a mall mioity o the

    ole populatio. With the comig wave o ole

    people, a utue challege will be impovig the liveo people eiig i thei ow home, ote iolate

    om amily a ie.

    Batig calle o exploig cot-eectivee

    a ie eect o at-bae itevetio;

    uppotig collaboatio betwee eeache

    a at-bae pactitioe; a couctig

    emotatio with eaoe eeache to bette

    ueta mechaim a to yiel eciptio

    though eh eye.

    muSic thErapy or dEmEntia

    Julee Joho, a muicia a well a a poeo,

    peete eviece o the theapeutic ue o muic

    pecifcally to help emetia patiet. Ealy tuie

    ocue o uig muic to help maage the behavio

    o people with evee emetia, uch a eucig

    agitatio o aggeio, a well a iceaig alete.

    numeou tuie alo have ocumete that Ad

    patiet etai muic kill a muic memoy (a

    peeve memoy o muic) log ate thei othecommuicatio a cogitive kill imiih.

    Joho eviewe 24 tuie that ue

    muic to maage emetia ymptom. The muic

    itevetio wee vaie a iclue liteig to

    live o ecoe muic, paticipatig i igig o

    playig itumet, muic theapy, a combiig

    muic with movemet. The paticipat geeally

    wee i evee tage o Ad o othe emetia a

    live i aite livig ettig. The ample wee

    typically mall, aou 25 ubject; may wee otaomize to teatmet. The tuie late ix

    to eight week, with the itevetio, o expoue,

    agig om 30 to 60 miute, two to thee time

    pe week.

    Joho epote that may o the tuie ou

    that muic itevetio euce ome egative

    behavio aociate with emetia, icluig

    aggeio, agitatio, axiety, epeio, a

    waeig. A ew ou impovemet i cogitive

    kill (pecifcally memoy a laguage). But othe

    tuie ou o chage i behavio o ou a

    chage i behavio but ot i cogitive kill.Thee tuie epote iteetig a

    pomiig eult but i ot povie tog

    cietifc eviece o efcacy o itevetio

    becaue o eig hotcomig. noe iclue a

    CBA o the itevetio. she quote the cocluio

    o the Cochae goup eview o te tuie a a

    ummay o the ituatio: Thee i o ubtatial

    eviece to uppot o icouage the ue o muic

    theapy i the cae o ole people with emetia.

    Futhe, the methoological quality o thee mall,hot-tem tuie wa geeally poo, a wa the

    peetatio o eult.11

    Joho looke at thee aitioal tuie

    a eache a imila cocluio. I geeal, the

    citicim wee imila to thoe ietife by othe

    eeache a ummaize above: iaequate

    ample a metho, limite a iappopiate

    outcome meaue, weak tatitical metho, a

    icocluive eult.

    I cotat, the tuie o phamacological aget

    Joho eviewe wee well-eige, iteatioal

    rCT coomig to high eeach taa.

    nevethele, the eult wee iappoitig, howig

    that eithe doepezil o Mematie wee eective

    o teatig agitatio i Ad a that they ha egative

    ie eect. Futhemoe, thee ug i ot euce

    bue o caegive, which i a igifcat pat o the

    cot o Ad.

    Joho alo eviewe the fig om tuie

    o othe ophamacological itevetio with

    11 Vik, A., Buima, M., scholte, r. 2011. Thee Ino subtatial Eviece to suppot o dicouagethe Ue o Muic Theapy i the Cae o Ole Peoplewith demetia. Cochae demetia a CogitiveImpovemet Goup. Publihe olie a acceeat summaries.cochrane.org/CD003477/there-is-no-substantial-evidence-to-support-nor-discourage-the-use-of-music-therapy-in-the-care-of-older-people-with-dementia.

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    12 The ArTs And Aging: Building The science

    emetia patiet.12 Thee tuie looke at uch

    itevetio a behavio maagemet, amily-bae

    copig theapy, eviometal maagemet, ha

    maage, a phyical activity. Howeve, the tuie

    tee to ue om the ame methoological

    poblem a the muic itevetio pogam.

    ms is app Ps

    depite thee limitatio, Joho eview o muic

    itevetio howe they may pove eective i

    ome cicumtace. At a miimum, eveal tuie

    uggete that muic helpe impove behavioal

    ymptom. Muic ha the potetial to impove the

    quality o lie o both the peo with emetia

    a caegive. Muic alo ha the potetial to be

    cot-eective, impoe miimal ik, a i eailyacceible, icluig o cultually ivee ole

    ault a thoe with emetia.

    Joho peete eveal uggetio o

    impovig the quality o eeach tuie o muic

    itevetio:

    Ecouage co-talk betwee muic a

    emetia eeache (iteicipliay team,

    icluig tatiticia a methoologit).

    Coie uig iteatioal cliical tial citeia

    o coult the Alzheime dieae Coopeative

    stuy (AdCs), a acaemic eeach cootium

    that tuie itevetio o Ad.

    12 Fo example: Coope, C., et al. 2012. sytematicreview o the Eectivee o no-PhamacologicalItevetio to Impove Quality o Lie o People withdemetia.International Psychogeriatrics 24(6): 856-70 (Ju); Gauthie, s., et al. 2010. Eect o doepezilo Activitie o daily Livig: Itegate Aalyi oPatiet data om stuie i Mil, Moeate a sevee

    Alzheime dieae.International Psychogeriatrics 22

    (6): 973-983; Hulme, C., et al. 2010. no-PhamacologicalAppoache o demetia that Iomal Cae Might Tyo Acce: A sytematic review.International Journal ofGeriatric Psychiatry 25 (7): 756-763; Livigto, G., et al.2005. sytematic review o Pychological Appoacheto the Maagemet o neuopychiatic symptomo demetia.American Journal of Psychiatry 162 (11):1996-2021; Olaza, J., et al. 2010. nophamacologicalTheapie i Alzheime dieae: A sytematic review oEfcacy.Dementia and Geriatric Cognitive Disorders 30:161-178.

    Iclue moe ethically a cultually ivee

    ole ault.

    develop bette theoetical moel to iom

    eeach agea.

    Coie ovel way to captue the eect o

    muic o ole ault.

    Iceae baic eeach about poceig/

    expeiece o muic o ole ault.

    Coie itevetio eect o both Ad a

    o-Ad emetia.

    Coie muic itevetio i ealy-tage

    emetia a poibly aco the liepa.

    Mot people will ot evelop emetia but may

    expeiece agig-elate cogitive eclie. They

    coul alo beeft om muic itevetio.

    (The impotace o muic though the liepa i

    ackowlege with govemet uppot i Fila,

    o example.)

    coSt-BEnEit analySiS

    Emmet Keele aee the ifcult but eceay

    execie o couctig CBA o at itevetio.

    I thi couty, which ha the wol mot

    expeive healthcae, it i alway impotat to

    ak how much a itevetio will cot a jutiy

    why moey houl be pet o it athe tha ome

    othe itevetio.

    At itevetio have may itagible

    beeft, which may accue to caegive o amily

    membe a well a the patiet. Thi acto make

    it hae to couct CBA, which equie umeic

    iput ito a table o coeca o iect a iiect

    cot a well a the etimate meical cot oet by

    the itevetio.

    Keele peete a pime o the vaiou

    metho o weighig cot veu beeft o ay

    health itevetio. reeache geeally opt o

    a ull CBA, the taa o aeig the impact

    o egulatio o a iuty. Cot-oly aalye

    ae ueul i buie but ae ot appopiate o

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    The ArTs And Aging: Building The science 13

    at itevetio becaue health itevetio,

    whethe at pogam o bloo peue ceeig,

    ae meat to impove health, ot jut to ave moey.

    Aothe type o aalyicot-eectivee (CE)

    aalyiocue o oe eect o outcome a may

    be appopiate oly o ome at itevetio. Theyae ot eige to captue multiple eect o the

    patiet a poibly o othe.

    Although ome beeft ae vey ifcult to

    quatiy, eeache ee to place a olla value

    o all eect to obtai the et value o the pogam.

    They mut go though the ame execie with

    othe optio, uch a the tatu quo o aothe

    itevetio.

    He ote that eeache ee to pick

    meaueable objective, povie eviece that apogam wok, a how how it compae with the

    cot a beeft o othe itevetio. The tep

    iclue ae:

    speciy exactly what i beig cote.

    Chooe which beeft a impact to cout.

    Peict cot a impact a moetize them.

    dicout utue olla to peet value.

    Calculate the et beeft a chooe the

    pogam with maximum et beeft.

    Couct a eitivity aalyi o key aumptio

    a coie the impact i aumptio ae

    chage.

    The cot compie the cot o each activity i the

    pogam, icluig et-up (taiig a plaig, o

    example) a ogoig cot. Typically, eeach cot

    ae exclue.

    The owteam cot ae ote le cetai,

    eve though they may be ubtatial. I meical

    aalye they ae moele uig ieae hitoy

    moel: suppoe the at pogam potpoe ety

    ito log-tem cae. Thi coul elay majo cae

    cot, Keele ai, but quatiyig that eect equie

    a umbe o aumptio.

    The actual cot o upplie, et, o woke

    ae aothe iput. Labo cot ae calculate by

    etimatig the time equie o each activity at

    aveage wage. The value o volutee time poe

    a ieet quetio becaue thee i a oppotuity

    cot: What ele coul oe be oig i etie? I a

    imila vei, houl amily caegive time be eteea $0 o a appopiate wage ate? People may like

    the eelig o helpig thei paet o poue, but

    withi limit. At ome poit, they may be willig to

    pay to egai ome o thei time.

    The paticipat alo coul be oig omethig

    ele with thei time, a the pogam coul alo

    icu a oppotuity cot o them. Howeve, i the

    pogam i u, the the paticipat time woul be

    coute a a beeft a ot a cot.

    Q ajs l ys (Qalys):cb dss hBfs

    Health pogam aim to impove lie expectacy a

    uctioig, but the quality o lie i alo impotat.

    Feelig healthy o ft, comotable a pai ee

    eve happy, ueul, a ocially coecteall help

    efe the quality o thoe exta yea o lie.

    Keele poite out that a lot o health pogam

    ae ot jut aime at exteig lieiee, peopleuego milly ageou opeatio to impove

    uctioig o gai ymptomatic eliethu a CBA

    ee to coie impovemet i health a i the

    quality o lie. QALY age om 1 (excellet health)

    to zeo (eath), with vaiou tate o impeect

    health i betwee. Thee value ae etemie by

    health-elate quality o lie (HrQL) weight

    applie to each yea o lie, i.e., QALY = yea x

    HrQL acto o thoe yea. Oe ummay meaue

    aggegate QALY.13

    13 The ajutmet atio o quality o lie give pecifciabilitie i etemie uig uvey epoe aboutthe umbe o iability-yea a peo woul be willigto oego o evey yea o iability-ee lie. Fo a toke

    victim, the value i 0.7, meaig that people have ai theywoul, o aveage, give up 14 o the ext 20 yea o lie ithey coul avoi livig with toke iabilitie.

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    14 The ArTs And Aging: Building The science

    W is d v h?

    Accoig to ecoomic theoy, the value o

    omethig i what people ae willig to pay o it

    (Willige to Pay [WTP]). Health i a impotat

    outcome that i ot puchae iectly, o ha o

    clea pice. reeache ca etimate WTP value o

    health i two way: 1) implicit choice, e.g., haza

    pemium wage o ageou job; a 2) uvey

    that ak people what they woul pay o pecifc

    goo. The liteatue o both thee metho how

    that people ae willig to pay betwee $1,000 a

    $10,000 to euce thei ik o yig by 1/1000o

    example by payig ubtatially moe o a top

    ugeo to peom a iky opeatio. The value o a

    aitioal QALY age om $50,000 to $250,000.

    a r-W cBa exp:c gp

    Keele explaie the baic piciple o CBA with

    ega to at itevetio, ecibe i a pape

    by Gee Cohe a colleague. I the tuy, about

    160 ambulatoy ole ault wee aige to a

    choale goup o thei uual activity.14 Paticipat

    i the poeioally u weekly eio epote

    bette oveall health (to 0.1 taa eviatio), two

    ewe octo viit, a ewe ove-the-coute

    meicatio a all tha the cotol goup. I thi

    example, Keele aume that 0.1 taa eviatio

    i health i equivalet to a 0.01 iceae i the cale

    o health quality o lie ajutmet that goe om 0

    to 1 o excellet health. He i ot aig a value to

    othe activitie.

    Net Costs

    Keele aume $50,000 o the cot to maage

    the poeioal choale goup. He etimatea meical avig o $250 o each o the 80

    14 Cohe, G.d., Peltei, s., Chaplie, J., Kelly, J.,Fith, K.M., a simme, s. 2006. The Impact oPoeioally Coucte Cultual Pogam o thePhyical Health, Metal Health, a social Fuctioig oOle Ault. The Gerontologist 46, o. 6: 726-734.

    paticipat i the choale goup i avoie octo

    viit, o $20,000 total (80 x $250). so the et cot i

    $30,000 ($50,000-$20,000).

    Net Beneft

    Aumig WTP o each aitioal QALY i $50,000,Keele etimate that the iceae health i woth

    $500 o each paticipat (0.01 x $50,000). He

    aume the u o igig i woth $10 each week

    to each paticipat; 30 week o u the a up to

    $300 o u. The aveage total iiviual beeft i

    thu $800, o the total et beeft o the pogam

    paticipat woul be $64,000 (80 x $800).

    The pogam ha a et poitive eect ($64,000

    > $30,000), but by Keele ough calculatio the

    pogam i ot eceaily cot-avig a thee i tilla et cot o $30,000.

    coStS and BEnEitS oEvidEncE-BaSEd programS

    Melia Catoa-Bikley a Tom Pohaka

    peete the iue ivolve i etemiig cot

    a cot-eectivee whe talatig eeach

    i at pogam ito eviece-bae pogam i

    a commuity. They examie exitig moel o

    aeig a implemetig phyical activity (PA)pogam to impove the health a well-beig o

    ole ault, becaue, they ai, eeach o the

    impact o the at to health a well-beig i ole

    ault i imila to eeach o lietyle a health

    pactice uch a execie. PA a at itevetio

    hae imila iue a baie i etemiig cot,

    cot-eectivee, a the public health impact o

    pogam.

    They outlie the baic quetio to ae

    beoe lauchig a itevetio pogam:

    1. What ae the pecifc at itevetio a

    populatio to be tuie?

    2. What ae the health beeft o paticipatig a

    the coequece o ot paticipatig?

    3. What ae the potetial baie to paticipatio?

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    The ArTs And Aging: Building The science 15

    4. How ca we evelop ucceul itevetio

    a the policie to pomote them i ole

    populatio, while ietiyig the citeia o

    which to evaluate thei ucce?

    Pohaka maitaie that the awe to all o theequetio ee ito the cot a cot-eectivee

    o a pogam. I paticula, it i impotat to captue

    meaue o pevalece, iciece, ateceet,

    cot outcome, acto aectig the iitiatio a

    maiteace o a pogam, a fally, bigig a

    pogam up to cale.

    Catoa-Bikley eview o at pogam

    ivolvig ace, choale, theate, piao, a ceative

    witig ou a umbe o poitive eect o

    geeal health. specifcally, thee iclue lowemeicatio ue; ewe all a bette balace;

    impove cogitio; eceae hotility, axiety,

    a epeio; a iceae ee o matey a

    o well-beig.15 Although eeache wee goo at

    ecibig the itevetio, they wee le iliget

    about ocumetig the oage, uch a time a

    iteity, a the tuie eee moe ogaizatioal

    tuctue. Catoa-Bikley coclue that awe

    to the baic eeach quetio ae iufciet to

    povie a tue CBA. Both eeache agee that the

    efcacy o thee pogam ee to be etablihe

    beoe the cot ca be evaluate a the eeach

    talate to commuity-bae pogam.

    Pohaka ote that while cot mut be

    coiee, it might be utile to ty to opeatioally

    efe cot at thi time. Likewie, it i ifcult to

    etimate the total beeft om a tuy. Aothe way

    o evaluatig cot i by lookig at the tue value o

    what we have a the public health impact o what

    we have oe. He ecibe how at pogam

    opeate withi a boae ecological amewok.

    Cuet eeach i oiete to the iiviual i

    a cotolle o emi-cotolle ituatio. Yet the

    15 Catoa-Bikley, M., noelke, L., Pohaka, T., asataiao, W. 2010. Impact o At Paticipatio oHealth Outcome o Ole Ault.Journal of Aging,

    Humanities and the Arts 4: 352-367.

    itepeoal, ititutioal, a commuity elemet

    have a uctio a povie a ettig i which thee

    occu. Thee ecological acto cotibute to the

    tue cot. Uetaig the iteelatiohip o

    actothat elemet have a uctio a well a a

    locatiohelp u etimate cot. He alo ote thateeache o ot ee to iolate pecifc apect i a

    pogam ha multiacete apect.

    He eumeate elemet that efe eviece-

    bae welle pogam a health pomotio

    pogam. Thee pogam:

    All iclue a theapeutic elemet (teatmet)

    a a well-evelope tategy o implemetig

    the teatmet (pogam elivey).

    May iclue healthy ole ault a well a thoe

    with moeate to igifcat health coitio.

    documet the impact o meaigul

    health outcome a elate emogaphic,

    pychoocial, a eviometal coelatio

    that iuece the behavio.

    Iclue compeheive, multiacete

    itevetio appopiate o ole ault.

    documet eviece o a ytematic eview a

    a eviece-bae pogam.

    The talatio o cietifcally tete eeach

    fig to commuity-bae health pomotio

    pogam i ote low, agmete, a ubject to

    peculatio by the pactitioe commuity. Pogam

    have the geatet chace o ucce i thei metho

    a goal ae well efe a ocumete, iclue

    a CBA, a ae aaptable o a vaiety o eal-wol

    ituatio.

    Pohaka uggete uig the rE-AIM

    amewok to etemie the oveall public healthimpact o pogam:Reach,Eectivee,Aoptio,

    Implemetatio (coitecy a felity), a

    Maiteace.16

    16 A explaatio o a eouce o thoe watig toapply the rE-AIM amewok ca be ou at: www.re-aim.org.

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    16 The ArTs And Aging: Building The science

    He alo eumeate ecommeatio o

    eucig cot, etemiig cot-eectivee,

    a ehacig oveall impact, icluig ocuig

    o eetial elemet, coieig the cotextual

    acto, a plaig o iemiatio. He uge

    eeache ot to wait o eult om goltaa eviece-bae pogam. He coiee

    a impotat objective o thi wokhop houl be

    to iemiate the fig aleay kow. Fially,

    quotig eeache Lay Gee (2008), he ai, I

    we wat moe eviece-bae pactice, we ee

    moe pactice-bae eviece.

    Pohaka expect a polieatio o ew

    eviece-bae pogam a the fel avace.

    Howeve, he wae that thee ee to be a

    coepoig eot to impove the quality, pomotethe exibility, a ehace the public health impact

    o thee pogam.

    applying coSt-BEnEit analySiS

    William specto illutate eal-wol iue

    aociate with CBA with a theoetical example:

    a chambe muic camp o ole paticipat. It i

    impotat to etemie who will beeft a who

    i likely to pay o the pogam. Thi i ot alway

    taightowa becaue ome beeft ae moepublic tha pivate. He ote that the CBA i meat

    to etemie the value to ociety i olla tem,

    with beeft expee i health eect a cot

    expee i olla. The cot a beeft o ot

    alway accue to the ame people.

    defig the cotext o the itevetio i alo

    impotat: Who i uig the pogampublic o

    pivate etitie, o the paticipat themelve? Will

    it be poible to evaluate health eect i tem o

    euce meical cot o ewe ick ay?

    df i

    A metioe i othe peetatio, eeache

    ee to ocumet the iteity o the itevetio.

    reeig to a hypothetical example he calle the

    Goup At Pogam (GAP), a muic peomace

    goup, specto icue how eeache ee

    to kow iteity o pactice, ot jut umbe

    o hou, becaue the geatet cogitive beeft

    come whe paticipat take o ifcult tak. Ae

    membe ight-eaig muic o pacticig o a

    goup peomace? How ifcult i the muic? Allcompoet ee to be ocumete o they ca be

    eplicate to the extet poible. specto ote that

    muicia bai ie by how much they pactice.

    Mot poeioal pactice a aveage o about two

    hou a ay, while a active amateu might aveage

    30 miute a ay at mot, he peculate.

    Othe apect o the pogam ca have

    impotat eect, uch a whethe a poeioal

    o amateu coach u the pactice, o whethe

    pactice ae u by paticipat themelve, a icommo with chambe muic goup.

    It alo i impotat to ak what othe apect o

    the itevetio ae challegig the paticipat. I

    the hypothetical GAP muic camp, ole paticipat

    may have to wok hae tha youg ault to keep

    tack o muic a pactice cheule. The camp may

    povie phyical challege o ome people who

    have mobility limitatio o who ae jut tatig o

    eleaig a itumet. Each activityeheaal,

    goup pactice, a the phyical equiemet o

    playig ieet itumetmake ieet

    ema o the bai.

    i Bfs css

    Beeft o thi itevetio might iclue impove

    health a quality o lie, geate job pouctivity,

    lowe healthcae cot, ehace ocial iteactio,

    impove cogitive a moto kill, a potetially,

    aatomical bai chage. Beeft may ie

    epeig o the tak, the ole o the team, a who

    i o the team. Fo example, balloom acig may

    be a geate cogitive challege o a ma becaue he

    lea the pai. sight eaig muic might equie le

    eot tha peectig ew challegig muic.

    The cot o itevetio mut iclue all

    apect o the pogam, icluig time o eheaal

    a peomace, maketig, pace etal, a

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    The ArTs And Aging: Building The science 17

    tavel. reeache ee to coie the epeciatio

    o itumet a a potetial cot. specto uggete

    builig i the cot o a acilitato a ceatig

    eucatioal mateial o a tool kit o ta a

    coume. The cot alo houl be compae to

    thoe o othe pogam.specto coclue that, a with execie

    pogam, people will oly eap the beeft i they

    ae puhe to exet themelve, whethe phyically

    o metally. I act, i uch a pogam, the wot

    playe may get the mot health beeft becaue

    the pogam may be moe challegig elative to

    thei iitial kill. Howeve, the equiemet ee

    to be eaoable o the kill level o paticipat

    to avoi exceive utatio a to miimize

    pogam attitio.

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    18 The ArTs And Aging: Building The science

    S

    aa Cewe moeate a eio

    o the elatiohip o aethetic a

    eig acto to health a quality-o-

    lie-elate outcome o ole ault ilog-tem cae a aite livig acilitie. she

    ote that whe ole people move om thei

    home to a aite livig acility, they ae givig

    up ome iepeece, etablihig elatiohip

    with a ew uppot etwok, a ajutig to a

    uamilia eviomet, all o which ca cotibute

    to cogitive a emotioal te. A health a

    ocial cae povie ty to miimize the te a

    eue the ew eviomet i timulatig, they

    ee to ueta how the peo a hi o he

    eviomet ae like. Cewe alo metioe

    that, a the ole populatio become moe ivee,

    cultual ieece i the phyical uouig may

    ee to be coiee.

    I hi peetatio, Victo regie emphaize

    the impotace o makig aite livig home

    welcomig to amily membe o all age. I hi tuy

    o 300 aite livig home i the Uite state

    a othe Euope, regie ietife impotat

    eig elemet that ecouage iteactio a

    activity, while poviig pivacy a a eietial

    eel.17 The eig houl allow o a pimay pathway

    with lik to activity oom, iig aea, a

    17 regie, V. 2002.Design for Assisted Living: Guidelinesfor Housing the Physically and Mentally Frail. (new Yok:Joh Wiley & so.)

    eatig aea o viito a well a iiviual oom.

    Wiow, hal-wall, o balcoie ca allow eiet

    to peview oom beoe they ete them, o they

    ca ecie whethe they wat to joi the goup oactivity a avoi ueceay axiety about chace

    ecoute.

    regie avo builig activity oom that

    might appeal to a limite goup, uch a a ecoig

    o at tuio, a well a all-pupoe oom that ca

    accommoate a age o moe popula activitie. He

    ote that the eig o ta ofce i alo impotat

    to the oveall eel o a builig. some cae acilitie

    ue oatig ek o ofce with dutch oo to keep

    the ta moe viually acceible to eiet.

    demetia patiet might beeft om aitioal

    pecifc eig eatue. A ymmetical oo pla, o

    example, ca be ioietig to ole eiet, a

    aymmetical layout, with itictive lamak,

    like a tatue o wall ecoatio, ca help oiet

    eiet. May emetia patiet uctio bette

    whe poeio ae viible, a might o example

    beeft om havig ope cloet, with wie baket

    o toage. dutch oo a wiow that allow

    eiet to ee ito othe oom alo ca be

    paticulaly helpul to oiet thee eiet.

    Luh lacapig a atual light i iteio

    aea ae amog othe eig elemet that

    cotibute to the ucce o a aite livig acility.

    The co ca be tailoe to the ituatio a the

    populatio goup. some eietial home have

    ou that emetia patiet eact well whe thei

    aeStheticS and deSign ingrouP living arrangementS

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    The ArTs And Aging: Building The science 19

    ow at i pote o hallway outie thei oom.

    repoig to a quetio om the auiece about

    whethe a eig elemet that i beefcial to oe

    peo might be etimetal to aothe, regie

    ecogize that eig ee to be aaptable o

    eiet ca etai thei ee o iiviuality. Healo ackowlege the value o alteative moel

    that accommoate the ee o ole ault like the

    village movemet o the evice houe i nothe

    Euope, which have pogam that eve ole people

    livig i the uouig commuitie.

    A Batig ote i a late eio, eiet

    elom get the chace to eig a pace, o ceative

    way ae eee to aapt the cuet eviomet

    to be moe welcomig a appopiate o ole

    eiet. she ha a ocumetay i poge aboutthe Peelope Poject, i which ue o pace i a

    eietial home wa ecoceptualize.

    thEorEtical Background orESEarch in viSual art

    Kathy Hatho, a pioee i theapeutic health

    cae at, ecibe how viual at ha bee ue

    i healthcae o moe tha 600 yea, with ealy

    ue ote ocuig o eligiou theme, uch a

    heave a hell. I the 1860, Floecenightigale aee the impotace o the

    hopital eviometepecially eh ai a light

    i heNotes on Nursing.18 I ecet ecae, mot

    hopital a uig home have ue at to ceate

    a pleaat eviomet. Moe ecetly at i beig

    ue theapeutically.

    Hatho eviewe ome lamak tuie that

    emotate the health beeft o viual at. she

    peete thee theoie that uelie eeach i

    viual at a health:

    Popect a reuge Theoy: The ability to ee

    a the ability to hie ae key to ou uvival.

    Thi theoy hol that moe ma view at

    18 nightigale, F. 1898. Notes on Nursing: What It Is andWhat It Is Not (new Yok: d. Appleto).

    om thi pepective a i attacte to at that

    ha boa vita (epeetig popect) with

    viible place o eay euge, thu atiyig

    iate itict o fght o ight.19

    Emotioal Coguece Theoy: Ou emotioal

    tate bia ou peceptio o eviometal

    timuli i way that ae coguet o match ou

    eelig.20

    Biophilia Theoy: Millio o yea o evolutio

    have let huma geetically poe to epo

    poitively to atue ettig that otee well-

    beig a uvival o ealy huma.21

    A emial tuy o ie yea o ichage ata

    ou that ecovey om ugey wa ate o

    hopital patiet who taye i a oom with a view

    o a atual ettig tha o patiet with a view o a

    bick wall. The hopital tay wa hote (7.96 ay

    compae to 8.70 ay), ewe tog aalgeic wee

    eee, a uig ta wote ewe ote o the

    patiet who ha oom with the atual cee. Thi

    tuy, by roge Ulich, helpe lay the ouatio

    o eviece-bae eig (EBd).22 Aothe ote

    tuy ou that patiet who viewe eee atual

    cee beoe goig ito ugey ha lowe bloo

    peuea le peopeative tetha patiet

    who viewe aouig pictue.

    Ps, c, eisss a Pp a

    Hatho ote that agig i aociate with phyical

    chage that ca aect how ole people view at.

    19 Appleto, J. 1975. The Experience of Landscape. (Loo:Joh Wiley)

    20 Ulich, r., a Gilpi, L. 2003. Healig At: nutitioo the soul. I s. B. Fampto, L. Gilpi, & P. A. Chamel(E.),Putting Patients First: Designing and Practicing

    Patient-centered Care (pp. 117146). (sa Facico, CA:Joh Wiley & so)21 Wilo, E., a Kellet, s. 1993. The Biophilia Hypothesis.(Wahigto, dC: Ila Pe)22 Ulich, r. 2004. View Though a Wiow MayIuece recovey om sugey.Science 224 (4647):420-1.

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    20 The ArTs And Aging: Building The science

    Thi etemie what viual at i appopiate to

    iplay i ieet ettig. With agig, igifcatly

    le light i available to the etia; epth peceptio

    i impaie. Ole people ote evelop le cleoi

    a cataact a they ae moe aecte by glae a

    haow.demetia a othe cogitive impaimet alo

    aect how people peceive at. A the ee o time

    a place chage, the ability to ecogize commo

    object may eteioate. The emotioal chage with

    emetia mut be coiee whe electig at o

    emetia patiet. Hatho elaye a example i

    which a pictue o a atual lacape wa calmig

    o mot people, but looke empty to Ad patiet,

    who ake whee the people ha goe.

    ip vs a ds e

    nealy oe-hal (43 pecet) o hopital uveye

    i a ecet tuy ai they iplaye viual at i the

    belie that it beeft patiet a thei amilie a

    cotibute to a healig eviomet.23 Extapolatig

    thee fig, Hatho etimate that moe tha

    20,000 acilitie o ole Ameica have viual

    at, aectig moe tha 960,000 eiet. Hatho

    ote that at ca timulate emotioal uctio aca be a eective way to egage ole viewe.

    Mueum wolwie have pogam geae o

    ole people, eve emetia patiet. The Atit o

    Alzheime (ArTZ) pogam at new Yok Mueum

    o Moe At (MoMA) a othe mueum, o

    example, povie a oppotuity o peoal

    gowth a iight a allow paticipat to acce

    log-tem memoie.24 Wokig with MoMA ta,

    May Mittlema a new Yok Uiveity school

    o Meicie eeache ou that viual at

    pogam euce epeio, impove ocializig,

    23 state o the Fiel Committee. 2009.State of the FieldReport: Arts in Healthcare 2009. Wahigto, dC: societyo the At i Healthcae. Available at: thesah.org/doc/reports/ArtsInHealthcare.pdf.24 Atit o Alzheime, available at www.artistsforalzheimers.org/

    a iceae el-eteem amog paticipat.25

    A sweih tuy alo ou ocial a cogitive

    beeft o patiet who paticipate i a at

    pogam.26 A pilot tuy i fve Miwete uig

    home ou that pictue a bi ou impove

    the bathig expeiece o patiet, eucigagitatio a aggeio.27

    Sf ess expss as as

    Expeive at activitie help iiviual elax,

    povie a ee o cotol, euce epeio a

    axiety, ecouage playule a a ee o humo,

    a well a impove cogitio a el-eteem.28

    Hatho ote that makig at alo ca utue

    piituality a euce boeom.At alo ca eect the emotioal a cogitive

    coitio o the atit. Hatho iplaye a eie

    o awig by thee atit with Ad that clealy

    howe the eect o ieae pogeio ove time,

    with le etail, ieet colo, a moe abtact

    om, a the atit cogitive ability eclie.

    The eect o at a at activitie exte

    beyo the patiet. Hatho obeve the gowig

    ecogitio that iplayig viual at a ceatig at

    i the wokplace ca euce te o the healthcaeta a ca pomote moe compaioate, highe-

    quality cae. Accoigly, ome meical chool

    cuicula ae icopoatig a at compoet.

    Hatho aw a ee to lea moe about

    paticipatoy at pogam a about viewig at i

    25 The new Yok Uiveity Evaluatio o Meet Me atMoMA i available at: www.moma.org/meetme/resources/index#evaluation(accee novembe 6, 2012). seealo: Joe, K. 2009. Keepig Thoe with AlzheimeEgage. The New York Times. At ectio (Mach 12).

    26 Wiktm, B. 2002. social Iteactio Aociate withViual At dicuio: A Cotolle Itevetio stuy.Aging & Mental Health 6 (1): 82-7 (Febuay).27 Whall, A., Black, M., Goh, C., Yakou, d., Kupechmi,B., a Fote, n. 1997. The Eect o natualEviomet Upo Agitatio a Aggeio i Latestage demetia Patiet.American Journal of Alzheimers

    Disease, 12(5): 216-220.28 Cohe, G. 2000. The Creative Age. (new Yok: AvoBook Ic.)

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    The ArTs And Aging: Building The science 21

    a utuctue eviomet. The buig quetio,

    i he mi, i What happe whe the at oe

    ight uty? We imply have o iea.

    dESign or EvEryonE

    including oldEr adultSValeie Fletche expae o the icuio o the

    health apect o aethetic a eig, i paticula,

    uiveal eig that accommoate the mobility a

    cogitive ealitie o ole people.

    Fletche outlie thee boa categoie o

    uctioal limitatio: phyical; eoimoto; a

    bai-bae, icluig cogitive uctioig a well

    a metal health. she emphaize that vaiatio i

    ability i omal a oiay, a that mot people

    will expeiece ome limitatio uig thei live.

    Thu, uiveal eig i ot jut about evig

    the iable o ole people, but evig eveyoe.

    Uiveal eig embace the eig o place,

    thig, iomatio, a commuicatio to expa

    acceibility to the wiet pectum o ue i a

    wie age o ituatio.

    Equitable ue i the oveachig a

    taceig piciple o uiveal eig. Ue

    houl be ituitive a equie miimal phyical

    eot. The bet evaluatio o ucceul eigcome om people at the ege o the pectum o

    ability a agethoe with the geatet limitatio

    a olet age. Thee ue expet uel iight

    a ipiatio a help geeate theoie, ot jut

    ietiy poblem.

    suppot o ceatig eablig eviomet

    o people with iabilitie, whateve thei age,

    ha gaie gou i ecet ecae. diability

    wa eefe by the Wol Health Ogaizatio

    (WHO) i 2001 a a cotextual vaiable. A uch,pecifc phyical, commuicatio, a ociopolitical

    eviomet ca peet baie o iiviual

    epeig o thei phyical o metal coitio.

    Iiviual may be iable oly i a give cotext.

    The magitue a pee o agig aou the

    globe i comig ecae a a ee o ugecy

    o ceatig a eviomet moe appopiate o

    ole people. The pecetage o ole people livig

    i commuity houig o log-tem cae iceae

    haply with age. Yet, the vat majoity o ole

    people will ot live i aite livig acilitie but i

    pivate home withi commuitie. Thi extethe ee o uiveal eig eatue well beyo

    ititutioal ettig. neithe icemetal tategie

    o pecial olutio will be eough, Hatho ai, a

    the ee i too geat.

    Uiveal eig i a way o thikig about

    huma iveity toay a about the powe o

    eig. she maitaie that eig i a ocial at a

    that it iuece the ee o cofece, comot,

    a cotol.

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    22 The ArTs And Aging: Building The science

    i

    the fal eio o the wokhop, thee paelit

    wee ivite to povie iight about eeach

    ee i the fel. They highlighte the tegth

    a weakee o cuet eeach a oeeuggetio o ew aveue a appoache goig

    owa, icluig pactical coieatio o the

    implemetatio o eviece-bae pogam.

    rESEarch dESignS thatcapturE long-tErm EEctS oart on thE aging procESS

    Magie Lachma emphaize the ee o eeach

    aco the liepa. reeach how a aociatio

    betwee at a cogitive peomace, but ca atlow the eect o agig? The eeach to ate o

    lietime eect o at paticipatio i ot cocluive.

    relate acto, icluig eucatio, cogitive

    timulatio, phyical activity, a ocial egagemet,

    may be the mechaim o chage.

    reeach ito the likage betwee at a

    agig mut be tailoe to the goal a ituatio.

    Expeimetal tuy eig uch a rCT ca vay

    coitio a cotol goup (aloe veu i

    goup, paticipatio veu obevatio, moeatephyical activity veu light phyical activity),

    o allow paticipat to chooe thei goup o be

    aige to oe. Ealie i the wokhop, it wa

    ote that uch eig houl ivolve coitet

    meauemet i pe- a pot- tet.

    developmetal a quai-expeimetal eig

    might be ue to examie the log-tem eect o at.

    They ca be logituial, co-ectioal, o eveal

    eig. They ca ae uch quetio a doe at

    aect the agig poce? I at bette o ole thayouge ault? The ABAB eveal eig (which

    ivolve a baelie, teatmet, eveal, a aothe

    teatmet) ca tet whethe a at teatmet make

    a ieece a, i o, whethe the eect iipate

    whe teatmet i emove.

    Aothe valuable eeach eig i the aily

    iay a expeiece amplig. Thi occu i a

    atual ettig, i which paticipat might log thei

    moo whe they ae oig at. O, paticipatio i

    at might be tie to uch meaue a bloo peue

    o cotiol, a well a moo o peceive te. Thi

    eig allow multiple outcome to be tacke,

    icluig phyical health, moo, cogitio a

    memoy, ocial egagemet, a logevity.

    Psp Ps a

    Paticipatio i the at mea leaig omethig

    ew, mateig a kill, a ejoymet. It ca be a

    lielog egagemet with log-latig cogitive

    beeft. At ca ai the aaptatio o ole

    people a they age, which ha bee ecibe a

    selective Optimizatio with Compeatio (sOC):29

    29 Balte, P., a Balte, M. 1990. PychologicalPepective o succeul Agig: The Moel o selectiveOptimizatio with Compeatio.SuccessfulAging:

    Perspectives from the Behavioral Sciences, page 1-34.(Cambige, U.K.: Cambige Uiveity Pe).

    reSearch gaPS and oPPortunitieS

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    The ArTs And Aging: Building The science 23

    selectioocu o goal; Optimizatiomea to

    achieve goal; a Compeatiomaitaiig goal

    i the ace o loe.

    Lachma ecibe the popect a pomie

    o at o agig populatio a wie-agig. They

    might ecompa theapeutic ue with emetiaa Pd, eich the geeal quality o lie, ive ew

    policie, a eve ceate ew maketig tategie

    o log-tem cae acilitie.

    intErdiSciplinarytEamS, intEgratEd artSintErvEntionS, and EaStErnapproachES

    At Kame agee with the wokhop paticipat

    about the ee o iteicipliay team. He

    uggete that, i aitio to cogitive cietit,

    biologit, a euologit, team houl iclue

    public health expet a health ecoomit.

    Kame alo calle o moe elightee

    achitect, a oee a examplethe Beckma

    Ititute Builig at the Uiveity o Illioi,

    which wo a eig awa i 1989. The builig

    eig ecouage iteactio amog eeache

    i ieet iciplie, which ca geeate ew

    eeach iea.He alo avoe coieatio o moe aimal

    moel i paallel with huma moel, a well a

    ew computatioal moel. A auiece membe

    quetioe whethe aimal moel coul be vali

    o eeach o the at becaue at i a uiquely

    huma omai. Kame ague that we ee ou

    peceptual, cogitive, a moto acilitie to egage

    i a appeciate at. He ote we ca lea a geat

    eal about thee acilitie om aimal tuie o

    bai uctio.Kame alo poite to leo that ca

    be leae om Eate health pactice a

    kowlege, although he ackowlege that thee

    wee haly icue i the wokhop. He poite

    eeache to the wok o itegative mi-boy

    taiig by Chiee eeache Yi-Yua Tag a

    pychologit Michael Poe.

    Kame alo agee with the call o a liepa

    appoach to the tuy o agig, to tack the log-tem

    eect o lielog habit a activitie, icluig

    execie a at paticipatio. With ew exceptio,

    whe people top the phyical execie, muictaiig, o othe at activity, the beeft go away.

    It woul be helpul to kow moe about how log

    beeft lat.

    He expee iteet i Kau eeach

    appoach o matchig the appopiate at

    itevetio with tagete (ote egative) agig-

    elate chage. The ight itevetio might be

    able to ehace auitoy a eoy uctio,

    ecogitio, a pehap auitoy ecall. reeache

    coul map the elatiohip betwee eiechage o outcome a at om. some outcome

    meaue, uch a bai imagig, ae appopiate o

    the laboatoy but ifcult to apply i a commuity

    ettig. Othe meaue ae moe potable, like

    iaie o witig poject, a eve ome compute-

    bae meaue. A iceaig aay o meaue

    i owloaable om iTue to iPa, phoe,

    o compute.

    Kame echoe the coce o Joho a

    othe that the eeach houl itiguih type

    o emetia, o example, the level o eveity a

    whethe o ot it i Ad. A eeache coul

    lea much about the efcacy o itevetio uig

    moe ivee populatio a aimal tuie. He

    metioe the wok o Heiette va Paag at nIA,

    which aw o aimal tuie ivolvig bai

    ioe.

    reeache alo ee to coie combiig

    itevetio to tet whethe uch a appoach

    might be moe cot eective. A at itevetio

    combie with tai chi, o example, might yiel

    eve moe beeft tha eithe itevetio aloe.

    Aimal tuie how, o example, that ocializig

    combie with execie ometime ha aitive,

    eve multiplicative eect. Echoig eveal othe

    paticipat, Kame tate that total uetaig

    about the uelyig mechaim i ot equie

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    24 The ArTs And Aging: Building The science

    beoe implemetig a pogam that ha pove

    eective.

    thEoriES, mEchaniSmS, lEvElSo analySiS, and rEplicaBlE,

    rigorouS dESignSBecca Levy coiee the eeach fig to be

    pomiig a thought the peete ha ietife

    ome outtaig example o both quatitative

    a qualitative tuie. she eumeate ou

    oppotuitie to avace eeach i the at to

    impove health a well-beig i ole ault:

    1: e rs B ts

    Levy uggete coieig simoto moel o

    ceative caee. Uig tetable hypothee, he ha

    examie the pheomeo o chagig ceative

    outlet to match cuet abilitie o limitatio.

    Becaue o athiti, o example, Gama Moe

    witche om emboiey to paitig at age 76 a

    ou eomou ucce i he late-lie puuit.

    Levy metioe aothe theoetical amewok:

    teeotype emboimet theoy.30 Fom a youg age,

    iiviual itealize el-ulfllig teeotype,

    o example, that agig equal eclie, a that

    ole people ae ot pouctive o ceative. Levy

    a colleague ou the ik o caiovacula

    evet wa highe amog ole ault who ha hel

    egative teeotype o agig i youg aulthoo.31

    reveig thi teeotype, uch that ole people ae

    value o thei expeiece a ceativity, coul yiel

    poitive health beeft.

    30 Levy, B. 2009. steeotype Emboimet. CurrentDirections in Psychological Science.18(6): 332-336.31 Levy, B., Zoema, A.B., slae, M.d. a Feucci,L. 2009. Age steeotype Hel Ealie i Lie PeictCaiovacula Evet i Late Lie.Psychological Science20(3): 296-298.

    2: ex Ws m asis ms e

    Futue eeach coul compae paive veu active

    at om a ty to meaue the egagemet level o

    paticipat. The iue o choice alo ca be tete:

    do health eect ie i people chooe thei at

    om athe tha be aomly aige to a eeach

    o cotol goup? The type o at alo ca be tete.

    I paticula, i it moe eective to ue cultue-

    pecifc at o to itouce ew at om?

    3: dp rpb, rs dss mp ls ass

    Levy echoe the call o moe igoou eeach

    eig, a cite Kau tuy o uetaig

    i oie a a goo example o the type o eeach

    eee. I um, Levy calle o toge tatitical

    metho, icluig amplig, taaize

    outcome, eplicable metho, a aequate

    cotol goup.

    4: i ms

    Levy ote that schlaug eeach o

    euocogitive platicity a Kau eeach o

    ole muicia bai uctio wee goo eeach

    example. Aothe example i emiicece, which

    may eve a a catalyt to peoal gowth o ole

    ault. The autho Hey roth, o example, wote

    ix autobiogaphical ovel betwee the age o 73

    a 89, beakig a 45-yea wite block. roth ai

    that witig allowe him to come to tem with pat

    actio he egette a he ace hi ow motality.

    Levy coclue by quotig robet Butle, who

    ai that baby boome mut ovecome thei eial

    o agig a avocate o ew way to pevet a

    maage Ad. The at ca be mobilize a a key

    eouce to give iiviual pupoe, which ca

    impove health a logevity.

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    The ArTs And Aging: Building The science 25

    unding opportunitiES oruturE Work

    The iue o uig o at itevetio eeach

    wa aee by eveal epeetative o the

    teeig committee a pooig agecie.

    Libeth niele (nIA), Joatha Kig (nIA),

    a William Elwoo (OBssr) metioe exitig

    nIH uig oppotuitie o multieoy eeach

    a o poject that lik eeache a commuity

    ogaizatio. reeache ca egite with the nIH

    though www.grants.gov, ceate a pofle, each o

    uig oppotuitie o iteet, a ubmit gat

    applicatio.

    suil Iyega (nEA) uggete that iteete

    patie alo moito commuicatio om the

    Feeal Iteagecy Tak Foce to Pomote reeach

    o the At a Huma developmet (www.arts.

    gov/research/TaskForce/task-force-members.html)

    about utue uig oppotuity aoucemet.

    The tak oce ite to acilitate eeach i thi

    aea by matchig ue with eeache.

    Jolee Joho metioe the Patiet-Cetee

    Outcome reeach Ititute (PCOrI) a aothe

    potetial uig ouce, which ca be accee at

    www.pcori.org.

    going orWard: promotEcroSS-talk and takE riSkS

    I hi ole a chaima o the wokhop teeig

    committee, davi reube ummaize the

    efciecie o the exitig eeach a the baie

    to avacig the fel. Techology, which wa ot

    aee iectly uig the wokhop, might

    povie cucial help i the implemetatio a

    evaluatio o at itevetio. The wokhop alo

    oly touche biey o calig-up a the felity

    o pogam, which will ee to be aee, alog

    with CBA, i at itevetio ae to be wiely

    aopte.

    He uggete that co-talk amog cietit

    a eeache might eae the hotage o expet

    cotibutig to the wok. He alo ai that eviewe

    o gat applicatio ee to be pepae to

    ackowlege ik, a to pehap u bol ew

    eeach iea a well a pove appoache. He

    ote that agig i a lot like lie: complicate a

    mey. dot u away om the mey.

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    26 The ArTs And Aging: Building The science

    S c mbs:

    David Reuben (Chai), Uiveity o Calioia, Lo

    Agele (UCLA)

    Sandra Edmonds Crewe, Howa Uiveity

    Art Kramer, Uiveity o Illioi

    Nina Kraus, nothwete Uiveity

    Becca Levy, Yale school o Public Health

    Helga Noice, Elmhut College

    Wsp Sps rpss:

    Marie A. Bernard, natioal Ititute o Agig

    (nIA), natioal Ititute o Health (nIH)

    Wen Chen, nIA, nIH

    Constance Citro, Committee o natioal statitic,

    natioal Acaemy o sciece (nAs)

    Emmeline Edwards, natioal Cete o

    Complemetay a Alteative Meicie

    (nCCAM), nIH

    William Elwood, Ofce o Behavioal a social

    sciece reeach (OBssr), nIH

    Sunil Iyengar, natioal Eowmet o

    the At (nEA)

    Nancy Kirkendall, Committee o natioalstatitic, nAs

    Jonathan King, nIA, nIH

    Rocco Landesman, nEA

    Lisbeth Nielsen, nIA, nIH

    Deborah Olster, OBssr, nIH

    Molly Wagster, nIA, nIH

    o Sps / as:

    Anne Basting, Uiveity o Wicoi Milwaukee

    Melissa Castora-Binkley, Uiveity o

    south Floia

    Kate de Medeiros, Miami Uiveity

    Valerie Fletcher, Ititute o Huma

    Cetee deig

    Kathy Hathorn, Ameica At reouce

    Julene Johnson, Uiveity o Calioia,

    sa Facico

    Emmett Keeler, rAnd a UCLA

    Margie Lachman, Baei Uiveity

    Tony Noice, Elmhut CollegeAlexandra Parbery-Clark, nothwete

    Uiveity

    Thomas Prohaska, Geoge Mao Uiveity

    Victor Regnier, Uiveity o southe Calioia

    Gottfried Schlaug, Beth Iael deacoe Meical

    Cete a Hava Meical school

    William Spector, Agecy o Healthcae reeach

    a Quality

    aPPendiX 1: WorkShoP ParticiPantS

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    The ArTs And Aging: Building The science 27

    Five pape wee pepae o the wokhop o

    reeach Gap a Oppotuitie o Exploig the

    relatiohip o the At to Health a Well-Beig

    i Ole Ault, natioal Acaemy o sciece,Wahigto, dC, septembe 14, 2012:

    de Meeio K, a Batig A. Shall I Compare

    Thee to a Dose o Donepezil?: An Overview o

    Intervention Research in Dementia Care.

    Hatho K. The Role o Visual Art in Improving

    Quality-o-Lie Related Outcomes or Older

    Adults.

    Kau n, a Pabey-Clak A. Music and Aging:

    Exercise or a Well-Tempered Mind.

    noice T, noice H, a Kame A. Participatory Artsor Older Adults: Benefts and Challenges.

    Pohaka Tr a Catoa-Bikley M. Cost and

    Cost-Eectiveness in the Translation rom

    Randomized Controlled Trials to Community

    Evidence-Based Arts Programs.

    aPPendiX 2: commiSSioned PaPerS

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    28 The ArTs And Aging: Building The science

    WorkShop on rESEarchgapS and opportunitiES orExploring thE rElationShip o

    thE artS to hEalth and WEll-BEing in oldEr adultS

    Spb 14, 2012

    500 Ft st. nW (t Kk B),room 100

    Wato, d.c. 20001

    Thi wokhop i peete by the natioal

    Acaemy o sciece, Committee o natioal

    statitic, at the equet o a cootium o the

    natioal Eowmet o the At a thee uitwithi the natioal Ititute o Health: the natioal

    Ititute o Agig, the Ofce oBehavioala

    social sciece reeach, a the natioal Cete

    o Complemetay & Alteative Meicie. The

    pupoe o the wokhop i to ietiy eeach gap

    a oppotuitie o exploig the elatiohip o

    at paticipatio a ceativity to phyical health

    a pychological well-beig i ole ault. It will

    povie a citique o the fel, icluig challege

    i uetakig eeach capacity-builig; a it willoe guiace o the eig o utue tuie a

    eeach uig oppotunitie.

    Pimay peake how i bold

    8:30

    is WeeCHAIr: David Reuben, UCLA

    8:35W B n asConnie Citro, Committee o natioal statitic

    8:45

    i Wsp osMarie A. Bernard, natioal Ititute o Agig,

    natioal Ititute o Health; Rocco Landesman a

    Sunil Iyengar, natioal Eowmet o the At

    9:00te res as ps iees ps We-Be,ce, Ses, m Ss oe as, e ue nepessesMOdErATOr:Art Kramer, Uiveity o Illioi at Ubaa

    Champaig

    9:05

    p as oe as:Beefs ceesTony Noice a Helga noice, Elmhut College;

    a At Kame, Uiveity o Illioi at Ubaa-

    Champaig

    9:35

    ms a: Eese We-teee mNina Kraus a Alexaa Pabey-Clak,

    nothwete Uiveity

    aPPendiX 3: WorkShoP agendanatoa Aamy o s

    natoa ra co

    dvo o Bavoa a soa s a educatio

    commtt o natoa statitic

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    The ArTs And Aging: Building The science 29

    10:05

    dsss

    10:20

    Bak

    10:30

    ce Beefs Weesses as tees e oe Be /p iees oe asEee dees ce, Ses,/ m abMOdErATOr:Becca Levy, Yale Uiveity

    10:35

    S i cp t ds dpz?: a ow irs d cKate de Medeiros, Miami Uiveity a Ae

    Batig, Uiveity o Wicoi-Milwaukee

    10:55

    ms B h dss:W W l c,l, S r SsGottfried Schlaug, Hava Uiveity

    11:15

    us ms m Sps d: W is S S?Julene Johnson, Uiveity o Calioia

    sa Facico

    11:35

    dsss

    12:00

    l

    1:00

    cs-Beef ases asse w e

    is as ps iees hee dee oe asMOdErATOr: David Reuben, UCLA

    1:05

    a P cs Bf assEmmett Keeler, rAnd a UCLA

    1:35

    cs cs-ess ts rz cts c e-Bs asPsThomas Prohaska, Geoge Mao Uiveity a

    Melia Catoa-Bikley, Uiveity o south Floia

    1:50

    dsss:William Spector, Agecy o Healthcae reeach

    a Quality

    2:05

    dsss

    2:20

    Bak

    2:30

    te res aeses dess he Q--le-reeoes oe as l-te ce assse l esMOdErATOr: Sandra Crewe, Howa Uiveity

    2:35

    hw ds asss l ltc eips Sss as PsVictor Regnier, Uiveity o southe Calioia,

    Lo Agele

    3:00

    t r vs a ip Q--l ros o asKathy Hathorn, Ameica At reouce

    3:25

    dsss:Valerie Fletcher, Ititute o Huma

    Cetee deig

    3:40

    dsss

    3:50

    Bak

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    30 The ArTs And Aging: Building The science

    4:00

    rese gs oes:a SPaelit will ummaize the wokhop a oe thei

    ow iight about eeach ee i the fel, aeig

    pecifcally uch theme a the tate o eviece o caual

    lik betwee at pogam a pecifc outcome;

    appopiate eeach eig to impove the quality o uch

    eviece; baic a talatioal eeach ee; a cot-

    beeft aalye a othe pactical coieatio o the

    implemetatio o eviece-bae pogam.

    MOdErATOr: David Reuben, UCLA

    4:05

    Margie Lachman, Baei Uiveity

    4:15

    Art Kramer, Uiveity o Illioi at

    Ubaa-Champaig

    4:25

    Becca Levy, Yale Uiveity

    4:35

    sss

    5:30

    Ajo

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    summay o a natioal Acaemie Wokhop,

    reeach Gap a Oppotuitie o Exploig the relatiohipo the At to Health a Well-Beig i Ole Ault,

    septembe 14, 2012