Arts and creativity interventions prove cost-effective for enhancing older adults' health and well-being

By Tarun Sai LomteReviewed by Benedette Cuffari, M.Sc.Dec 18 2023

In a recent study published in BMC Public Health, researchers assess the value and cost-effectiveness of arts and creativity interventions (ACIs) on the health and well-being of older adults.

Study: Arts and creativity interventions for improving health and well-being in older adults: a systematic literature review of economic evaluation studies. Image Credit: Krakenimages.com / Shutterstock.com

Supporting healthy aging

The percentage of the older adult population has increased in almost every country over the past several decades. An aging population reflects one of the successes of public health; however, it has numerous economic implications.

Equitable and sustained investment in health and well-being- is necessary to foster healthy aging and augment older individuals' lives, families, and communities. Several studies have reported the positive effects of ACIs on health and well-being-, as ACIs can improve older adults' quality of life, cognitive function, and well-being-. However, no systematic review has collated data regarding the value, cost, and cost-effectiveness of ACIs.

About the study

In the present study, researchers examine the economic effects of ACIs on the health and well-being- of older adults. Medline, Embase, PubMed, Web of Science, Econlit, the National Health Service Economic Evaluation Database (NHSEED), and clinical trial registries were searched for relevant studies.

Studies were eligible if participants were 50 years of age and older. Interventions included performance art such as singing, dance, drama, or theater, visual and creative arts including sculpture, painting, or art design, and creative writing like storytelling or writing poetry/narratives. All interventions were active, requiring the older adults to create art rather than view it. Furthermore, all interventions had to be delivered under professional guidance.

Cost-effectiveness, cost-minimization, cost-benefit, and cost-utility analyses were performed. Social value analyses were also included if they were used to inform decision-making and commissioning of services.

Two health economists performed title/abstract screening and reviewed full texts. Two reviewers extracted data on sample size, demographics, health, interventions, their effectiveness and costs, types of economic evaluations, benefits, quality assessment, results, and conclusions. Study quality was assessed independently by two reviewers.

Partial and full trial-based economic evaluations were analyzed using the Consensus Health Economic Criteria (CHEC)-extended checklist. Social return on investment (SROI) analyses were evaluated using an SROI-specific quality framework.

A narrative synthesis analysis was performed given the small number of evaluations, the possibility of heterogeneity, and the lack of consensus on methods to pool cost-effectiveness estimates.

Study findings

Over 11,000 records were identified in database searches. After de-duplication and additional rounds of screening, six studies were included in the review.

Of the included studies, two implemented health technology assessment (HTA) along with clinical trials to examine the cost-effectiveness of community singing. These two studies secured high scores on the CHEC-extended checklist.

The remaining four studies employed SROI analyses to evaluate art and craft interventions. These studies adhered well to suggestions for performing an SROI and scored highly.

Five studies were conducted in the United Kingdom and one in the United States. One study was designed for people with or without dementia.

Another study was explicitly intended for demented older adults and their caregivers. The remaining studies were designed for older adults without cognitive impairment. One study was conducted across residential, hospital, and community settings, whereas three were delivered in a community setting and two in care homes.

The duration and length of ACIs were variable, as some ACIs lasted one to two hours with multiple classes available, whereas others were more structured, with sessions lasting 90 minutes over 14 weeks.

Although program provision costs were similar to those identified using the HTA framework, the captured benefits were beyond the individual. They included stakeholders such as family members, care home personnel, and activity coordinators.

An extensive range of outcomes was captured across HTAs and SROIs, including quality of life, well-being, physical health, community inclusion, social isolation, communication, cognitive function, depression, sadness, loneliness, anxiety, and interest in everyday life. Although the evidence from singing interventions was encouraging, it was inconclusive.

Evidence from one trial suggested that the intervention caused significant improvements in participants' interest in life and loneliness. Nevertheless, there were no significant group differences in physical or cognitive outcomes and healthcare costs. All social value analyses reported a positive return on investment.

Conclusions

Participating in arts and creativity programs was generally cost-effective and offered a return on investment. Furthermore, ACIs positively impacted physical, social, and psychological health and well-being outcomes. However, the limited number of studies and methodological differences impede conclusively determining which ACIs represent the best value for money or are more cost-effective.

A notable finding from this study is the lack of evidence on the cost, value, and cost-effectiveness of ACIs for improving the health and well-being of older adults. To this end, only six studies were identified despite applying only a few restrictions. This may be due to limited research into ACIs in older populations or funders not seeing the added value of these evaluations.

This observation may reflect intrinsic biases in the political economy that favor marketable health solutions from which value can be appropriated as profit. Therefore, ACIs should compete for funding with other interventions, which would require a more robust and extensive evidence base than is currently available.