Alleviating Loneliness in Older Adults Through Creative Expression

Abstract:

Loneliness has become a pressing concern for elders, impairing physical and mental health and eroding quality of life. Creative arts engagement is an attractive programmatic intervention, enabled by selective modulation of brain activity, and reinforced by personalized and coordinated psychological and social features. Tested arts-based programs to address loneliness are available through Project UnLonely, an initiative of The Foundation For Art & Healing and deliverable by CBOs, offering scalable access to diverse older populations. Digital technologies (AI and VR), can tailor programs to individual needs and preferences, enhancing reach and impact. Arts-based programs, increasingly supported by digital technologies, show great promise in reducing loneliness.

Key Words:

loneliness, creative arts, awe, older adult health, digital health, Project UnLonely, Foundation For Art & Healing

Loneliness among older adults in the United States is a pervasive and pressing issue that warrants attention and intervention. As the aging population continues to grow, the prevalence of loneliness in this demographic has reached alarming levels. According to a report published by the National Academies of Sciences, Engineering, and Medicine (2020), approximately one third of adults ages 65 and older report feeling lonely, with a significant portion experiencing chronic loneliness.

This problem is exacerbated by factors that frequently accompany aging, such as the loss of spouses or friends, retirement, or caregiving. Additionally, older people have higher rates of physical limitations that restrict social interactions. Both reduced mobility and hearing loss have been found to correlate with higher risks of loneliness (Moeyersons et al., 2022; Shukla et al., 2020). Older adults from marginalized communities, such as immigrants, LGBTQ+ people, and incarcerated people, are particularly vulnerable to loneliness (Division of Population Health, 2023).

The consequences of chronic loneliness among older adults are profound, affecting physical and mental health. Detrimental impacts on mental health include increased risks of depression, anxiety, and cognitive decline. The isolating nature of loneliness can lead to a sense of purposelessness and despair, exacerbating existing mental health conditions. Additionally, loneliness has been linked to a higher likelihood of developing addiction and suicidal ideation among older adults, highlighting the urgency of addressing this issue (Perissinotto et al., 2012; Cacioppo & Hawkley, 2015). It’s no wonder that researchers have found that the mortality risk of loneliness is double that of diabetes and can be equivalent to smoking 15 cigarettes a day (Office of the U.S. Surgeon General, 2023). The loneliness epidemic will only grow, given that by 2050 one in four Americans will be older than age 65.

Options for most lonely older people are limited. Older adults with increasing physical and mental health needs and fewer social touchpoints are more likely to need either a part-time or full-time caregiver, who often becomes a primary source of social interaction. The caregiver role is often filled by unpaid family caregivers and/or low-paid caregivers who experience high rates of burnout, limiting their ability to be socially engaged, further isolating the care recipient.

Many older people turn to assisted living facilities to find community. But the price of these facilities has skyrocketed in response to an increase in demand. The median annual price of assisted living has climbed 31% faster than inflation (Rau, 2023). Additionally, most older people want to age in place. AARP found that 77% of adults ages 50 and older want to remain in their homes for the long term (Davis, 2022). This percentage has been consistent for more than a decade.

Fortunately, the growing awareness of loneliness and its burden on older adults has prompted increased exploration of new ways to address these challenges, one of the more innovative approaches being the use of creative expression with programmatically linked mindfulness and social learning components (Nobel, 2023). In addition, use of digital technologies to increase reach, participant engagement, and impact of arts-based programming offers significant advantages in terms of reduced cost, increased access to traditionally underserved population subsets, and outcomes (Nobel, 2023). This article will offer a brief introduction to and exploration of both.

Creative Arts as a Health-Enhancing Intervention for Older Adults

Recognizing the multifaceted nature of loneliness, innovative approaches are necessary to address the mental health needs of older adults. Creative arts, encompassing activities such as visual arts, music, dance, expressive writing and theater, have emerged as effective tools to engage and uplift older adults, reducing the risk of depression, anxiety, addiction, and suicide. Numerous studies have demonstrated the positive impact of creative arts on the mental well-being of older individuals (Galassi et al., 2022).

Engaging in creative arts allows older adults to express themselves, often fostering a sense of purpose and accomplishment. Whether through painting, playing a musical instrument, or participating in dance classes, these activities provide avenues for socialization and emotional expression, combating the social isolation that often accompanies aging (Cohen et al., 2006; Noice et al., 2013). Creative arts interventions have been shown to enhance cognitive function, improve mood, and reduce symptoms of depression and anxiety among older adults (Guzmán-García et al., 2016).

In the pursuit of effective interventions, the transformative role of creative arts—encompassing music, painting, photography, poetry, and dance—emerges as a powerful tool in mitigating social challenges. There has been a surge of interest recently in scientific foundations behind the assertion that creative arts can significantly reduce loneliness and isolation in older adults, focusing on three key mechanisms: the neurobiological impact, the facilitation of meaningful connections through storytelling, and the ability to induce awe and wonder (Nobel, 2023).

Neurobiological Impact of Creative Arts

The neurobiological underpinnings of how creative arts influence our well-being are increasingly well-documented (Magsamen & Ross, 2023). One notable aspect is the modulation of neurotransmitters and hormones associated with stress and pleasure. Scientific studies have consistently shown that engagement with creative arts can lead to a reduction in cortisol, the stress hormone, and an increase in serotonin, dopamine, endorphins, and oxytocin—the feel-good neurotransmitters that contribute to mood regulation and social bonding.

Studies have found that listening to music has a direct impact on cortisol levels, effectively reducing stress. One study measured salivary cortisol levels before and after exposure to relaxing music, highlighting the potential of music as a stress-reducing intervention (Khalfa et al., 2003). Additionally, the positive effects on neurotransmitters provide a neurochemical foundation for the subjective experiences of joy and connection that individuals often report during and after engaging in creative activities. Also, the study identified that the soothing effect of music on cortisol levels persisted even after the stressor had subsided, indicating a lasting impact on stress reduction.

Beyond the modulation of stress-related hormones, creative arts also can induce a cascade of neurotransmitters, including dopamine and serotonin, associated with pleasure and reward. Studies using neuroimaging techniques have demonstrated that listening to music leads to the release of dopamine in the brain’s reward centers (Salimpoor et al., 2011). This neurochemical response to music provides a biological basis for the positive emotions and enhanced mood reported by individuals engaged in musical activities, further highlighting the potential of creative arts in alleviating loneliness.

The role of endorphins, the body’s natural painkillers, is another facet of the neurobiological impact of creative arts. Endorphins are released during activities that induce pleasure and positive emotions, acting as natural mood enhancers. A study by Tarr et al. (2015) explored the release of endorphins in response to physical activities, including dance. The findings suggest that engaging in dance as a form of creative expression, can trigger endorphin release, contributing to an overall sense of well-being and potentially reducing feelings of loneliness.

Oxytocin, often referred to as the “love” or “bonding” hormone, is yet another neurotransmitter associated with social connection. The release of oxytocin is heightened during positive social interactions and emotional bonding. Of note, it has been shown that creative arts activities increase oxytocin levels (Tanaka et al., 2020). A study by Ditzen et al. (2009) demonstrated that intranasal administration of oxytocin led to increased positive communication and decreased cortisol levels during interpersonal conflicts. While this study focused on romantic relationships, it highlights the potential of oxytocin in enhancing social interactions, a mechanism that can be extrapolated to the social bonds facilitated by creative arts.

The Arts as a Catalyst for Health-Enhancing Storytelling

In addition to the neurobiological impact, creative arts offer an avenue for individuals to share personal narratives, fostering a sense of connection and understanding. Artistic expression allows older adults to communicate their experiences, emotions, and memories in a non-threatening and enriching manner. A study by Cohen et al. (2006) found that engaging in creative activities, such as writing or visual arts, was associated with better health outcomes and decreased loneliness in older adults. The act of storytelling through various art forms serves as a bridge, enabling individuals to convey their unique life stories, thereby fostering empathy and mutual understanding among peers.

Moreover, the sharing of personal stories is a reciprocal process. As one opens up through artistic expression, this invites others to reciprocate, creating a shared space for vulnerability and genuine connection. This reciprocal storytelling has been identified as a key factor in building social bonds and reducing feelings of isolation (Haslam et al., 2018). The narrative format of creative arts not only serves as a mode of self-expression but also as an instrument for weaving a tapestry of shared human experiences.

Creative Arts, Awe, and Reduced Loneliness

Awe is a positive feeling that arises when engaging with scenarios and circumstances that include a sense of vastness, linked to things not fully understood. Studies have shown that awe and wonder induced by programmed activities can contribute significantly to increased socially connecting behaviors among older adults (Sturm et al., 2022). Experiencing art, whether through visual masterpieces, melodic compositions, or rhythmic movements, has been linked to an expanded sense of self and connection to a larger universe of human experience. Awe-inspiring moments elicit a sense of interconnectedness and humility, diminishing feelings of loneliness by placing individuals within a broader context.

Research suggests that exposure to awe-inducing stimuli leads to increased prosocial behavior, emphasizing the potential of creative arts to enhance social connections (Rudd et al., 2012). Whether it be the grandeur of a symphony, the intricacies of a painting, or the poetry of movement, creative arts have the capacity to evoke emotions that transcend the self, fostering a sense of shared wonder that can be a powerful antidote to loneliness.

Creative Arts: Accessible, Enjoyable, Universal

The accessibility of creative arts across diverse cultural backgrounds further enhances their potential as tools for social connection in older adults. Music, painting, sculpture, photography, poetry, and dance have universal appeal, transcending linguistic and cultural barriers. Engaging in these activities allows individuals to connect through shared experiences and expressions that are inherently human, facilitating a sense of unity within diversity.

Moreover, the playful and engaging nature of creative arts makes them enjoyable activities to share with others. Participatory art forms, such as group dancing or communal singing, create spaces for collective expression, reinforcing a sense of community among older adults. The enjoyment derived from these activities adds a layer of positivity to social interactions, contributing to sustained engagement and, consequently, reduced loneliness.

In summary, the therapeutic potential of creative arts in mitigating loneliness and isolation among older adults is rooted in the convergence of neurobiology, storytelling, and the elicitation of awe and wonder. The impact of creative arts on neurotransmitters, coupled with the ability to share personal narratives and induce a sense of wonder, collectively offer an opportunity to achieve a profound reduction in feelings of loneliness. Furthermore, the accessibility and playful nature of these art forms make them versatile tools for fostering connections across diverse cultural backgrounds. As we delve into the rich tapestry of creative expression, we discover not only the profound impact it has on individuals but also its transformative potential to build vibrant and interconnected communities among older adults.

Implementing Creative Arts Programs in Community Settings

While the benefits of creative arts for older adults are evident, delivering these programs in community settings poses challenges. Barriers to implementation include limited funding, a lack of trained personnel, and logistical issues such as transportation for participants. Overcoming these obstacles requires a coordinated effort from community organizations, healthcare providers, and policymakers.

To enhance accessibility, community centers, senior living facilities, faith-based groups, and other community-based organizations (CBOs) can collaborate to establish and fund creative arts programs for older adults. Securing financial support from governmental agencies and private foundations can facilitate the expansion of these initiatives. Additionally, training healthcare professionals, teachers, social workers, and others with interpersonal engagement skills to lead creative arts sessions ensures the quality and effectiveness of the programs while expanding the workforce required to deliver them.

Community outreach and awareness campaigns are crucial for overcoming stigma surrounding mental health issues and encouraging older adults to participate in creative arts programs. By fostering a supportive and inclusive environment, communities can break down social barriers that contribute to loneliness among older adults.

Project UnLonely: Partnering with CBOs

CBOs often are limited in their ability to deliver impactful programming due to a lack of resources, including the staff time and funding to develop, deliver, assess, and scale programs. Through its signature initiative, Project UnLonely, from the Foundation for Art & Healing (FAH), is attempting to address these challenges by making available to CBOs a suite of tested, effective programming for older adults. These programs are designed to be accessible, sustainable, and adaptable to diverse audiences while helping participants build resilience, adopt pro-health attitudes and behaviors, develop meaningful social connections, and feel less lonely.

FAH provides delivery partners with a complete “toolkit” of delivery resources on a digital platform, including a complete curriculum with slides, facilitator guide, customizable promotional materials and handouts, and evaluation tools to assess impact and return on investment (ROI). The costs for partners are a modest investment of staff time, along with some simple, inexpensive art supplies. The programs can be delivered virtually or in-person.

Program facilitators do not need any clinical expertise or specific professional credentials. FAH provides extensive training and support to them to ensure ease of use and comfort with program delivery, which ensures ease of implementation for partners.

Each program is built around a framework that includes three components: creative expression, mindfulness, and social-emotional learning. All components have a strong base of scientific evidence behind their effectiveness in supporting mental and physical health.

Project UnLonely program participants engage in simple mindfulness exercises for warm-up and centering before doing creative work. Those efforts use art supplies to make drawings, collages, and other creative artifacts; allow participants to engage in journaling and expressive writing exercises; and create spaces to enjoy the experience of individual and group coordinated creative movement. After the art-making experience, participants share thoughts and feelings through a variety of social learning exercises.

Here are three examples from the Aging UnLonely program portfolio:

1. Aging Outside the Lines

Aging Outside the Lines is an 8-week program for older adults designed to reduce loneliness, build resilience, and encourage prosocial and pro-health behaviors.

Program participants have reported increases in their confidence in managing aging, ability to manage emotions, quality of life, perceived meaning in life, and feelings of resilience.

2. More Money in Your Pocket

More Money in Your Pocket is a 4-week program designed to help low-income adults older than age 50 reframe their relationship with financial insecurity, leading to improvement in financial self-care attitudes, knowledge, and behaviors.

Pilot tests showed increases in participants feeling less stress around money, more awareness of their emotions related to money, more awareness of benefits that can improve their financial health (such as SNAP), and more confidence in managing money.

3. Family Caregiver Programs

Caregivers Colors & Connection is a program developed to address the emotional and practical challenges of family caregivers of people with new onset Alzheimer’s.

Participants report the program helped them feel more connected to other caregivers, better able to identify ways to engage in self-care, more in touch with their emotions, and more familiar with available resources and support.

CBOs are essential components of a person-centered approach to the effective deployment of a variety of programs to address social determinants of health like social isolation and loneliness (Nguyen et al., 2021). Due to an often trusted relationship with their constituency, CBOs have a particularly important role to play in addressing loneliness because it’s a deeply personal experience, often accompanied by guilt and shame. In emerging payment models for healthcare entities that emphasize patient engagement as part of a population health model, there is growing funding for the delivery of community health programs, a trend that is likely to continue (Horwitz et al., 2020).

Digital Technologies as Catalysts for Arts and Connection Innovation

The COVID-19 pandemic pushed people to recognize the importance of technology as a tool for connection in the modern world—especially for socially isolated older adults. In an era of rapid technological advancement, digital technologies offer promising solutions to enhance the personalization, engagement, impact, and scalability of creative arts programs targeting loneliness in older adults. The integration of the Internet, virtual reality (VR), and artificial intelligence (AI) can revolutionize how these programs are delivered and experienced.

The Internet serves as a powerful tool for connecting older adults with creative arts resources, allowing them to participate in virtual classes, access instructional materials, and engage with a broader community of like-minded individuals. Online communication platforms have the capacity to free up community program administrators’ time, so they can shift their focus to program development.

In the future, emerging technologies have the potential to enhance the lives of older people in new ways. We have already seen an uptick of companies promoting robotic animal companions for older adults (Koh et al., 2021). However, rather than replace the need for human connection, these technologies can enhance it through creative programming. Virtual reality, with its immersive capabilities, provides an innovative platform for experiencing art and music in a way that transcends physical limitations.

AI, through personalized recommendations and adaptive learning, can tailor creative arts programs to the unique preferences and needs of each older adult participant. While there have been limited studies on the ability of VR to promote well-being in persons with dementia, there is a dearth of research on its broader application for older adults (Appel et al., 2021). More studies are urgently needed to further understand the exciting potential of both VR and AI in addressing the older adult loneliness epidemic.

Lastly, digital technologies also enable remote participation, addressing issues of mobility and transportation that often hinder older adults from accessing community-based programs. Virtual creative arts programs can be designed to accommodate various levels of physical ability, ensuring inclusivity and participation from the comfort of one’s home. Moreover, AI-driven analytics can track participant progress and assess the impact of creative arts interventions on mental health outcomes, allowing for continuous improvement and customization.

Combating loneliness among older adults in the United States requires a multifaceted approach that incorporates creative arts interventions and harnesses the potential of digital technologies. By addressing the root causes of loneliness, fostering community engagement, and leveraging innovative solutions, society can enhance the well-being of older adults and pave the way for a more connected and fulfilling aging experience.

Acknowledgements: With grateful acknowledgment and thanks to Ruthie Gottesman, first-year Master of Public Policy candidate at the Harvard Kennedy School for her contributions to the section on digital supportive technologies and to Jennifer Martin, director of programing at The Foundation For Art & Healing (FAH), for her contributions detailing currently available FAH arts-based programs.

Jeremy Nobel, MD, MPH, is a primary-care physician, public health practitioner, and award-winning poet with faculty appointments in the departments of Global Health and Social Medicine at Harvard Medical School, and of Health Policy and Management at the Harvard T.H. Chan School of Public Health. He is also president of The Foundation For Art & Healing. His book on loneliness, Project UnLonely: Healing Our Crisis of Disconnection, was released by Penguin Random House in 2023.

Photo credit: Shutterstock/dttmstock

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