Aging is a process we all go through with time, but it comes with loss and dealing with the changes in one's life because of that loss. This mainly affects the older adult population, which could benefit from art interventions (Guzman, 2007, p. 1069). For many gerontological facilities that work with the elderly, the focus is on understanding that loss by enriching the lives of older adults with recreational activities. Art, however, can serve as a recreational purpose and can be applied as a valid tool for improving psychological well-being. Understanding how art therapy could be applied to improving older adults' quality of life is essential to providing this population with the best interventions for improving their quality of life. Yet, not a lot of research has been conducted on the types of interventions that are most effective for addressing the impact of cognitive, physical, and emotional issues and grief associated with loss. Most past research with the elderly focuses on how creativity in the brain evolves as we age (Malchiodi, 2012).
Art therapy experiences can enhance creativity in older adults by facilitating novel connections and supporting increases in executive functioning (Hinz, 2019, p. 142). Art therapy plays a crucial role in maintaining and improving the older adult population's quality of life. Moosa (2017) described art therapy as the therapeutic use of art-making within a professional relationship with people who experience illness, trauma, or challenges in living. Art therapy should be used as a method that focuses on the older adult's strengths and abilities to help them review their lives and recognize their strengths. What art therapy interventions contribute to an increased quality of life for seniors who suffer from isolation because of dementia or living in a nursing home? This literature review will answer this question. This paper will explore the benefits and roles that art therapy plays on the ageing population. It will provide a systemic approach to the various art interventions used to address this topic by exploring the subject's relevant literature. These studies will focus on art and the ageing brain, its benefits, and possible interventions suitable for this population. The outcome will be a summary of all the literature review and studies done on the subject and how art therapy interventions are beneficial. In this art-based research, various response art will help the research manage and understand their work with the population being studied.
This systemic research will look at the literature surrounding the population of seniors mainly those living in isolation or nursing homes. It will examine the topic of loss and isolation 11 that negatively impact the lives of seniors, especially during the COVID-19 Pandemic. These topics serve as a framework for understanding the many challenges faced by this population and how art therapy interventions can serve to cope with these difficult challenges. The creative process through art responses will aim to explore the same challenging feelings and themes that seniors often face. Art therapy interventions will be discussed and suggested within the overall literature.
With this research, the purpose is to determine the overall difference art can make in a senior’s quality of life, happiness, memory ability and social world. With the systematic review, the goal is to provide more solid conclusions than past research on the topic. Another interest with this study is to determine how an environment, particularly a positive social environment can enrich the art-making abilities of seniors. The focus will be to provide a more concrete answer about which art interventions are most successful for their psychosocial benefits and why. Do art therapy interventions in a friendly safe environment contribute to an increased quality of life for seniors who suffer from isolation because of dementia or living in a nursing home? This study hypothesizes that the most beneficial art-based interventions when working with older adults are those that incorporate the sensory component of the Expressive Therapies Continuum (ETC) which is a model of creative functioning used in the field of art therapy that is related to creative processes both within and outside of an expressive therapeutic setting. With the results of this study, the hope is to understand how the sensory component of the ETC can be applied to art interventions in which the goal is to improve the quality of life of seniors. The study will hope to provide more solid conclusions than previous studies to help further the knowledge of future studies. This research will attempt to explore which art-based interventions are most suitable for eliminating feelings of learned helplessness.
Art therapy experiences can enhance creativity in older adults by facilitating novel connections and supporting cognitive functioning through increasing executive functioning (Hinz, 2019, p. 142). When working with older adults suffering from dementia or physical impairments, it is important to remember that this population deals with a significant amount of loss. The loss related to the consequences of ageing can cause a lot of emotional and physical challenges. These feelings of loss could be traumatic often resulting in depression and isolation 12 (Majeski, 2019). The literature review will explore the following topics: art therapy and the elderly, psychological challenges in the aging population, enhancing cognitive challenges in the aging population, art therapy interventions and art-based inquiry.
Art Therapy and the Elderly
Benefits of Art Therapy
Art therapy is thus used as an opportunity to provide for self-expression and introspection (Stephenson, 2006, p. 24). An elderly person would seek art therapy for various reasons. One of the most common reasons suggested by Malchiodi (2012) is to encourage socialization and thus avoid isolation which is common to that population. The elderly population has expressed a need for creative rehabilitation activities and psychosocial interventions and faces many challenges which as loss of independence and additional end of life issues (Malchiodi, 2012). Art therapy has many benefits such as helping seniors engage in a positive relationship, improving their quality of life, increasing motivation, decreasing loneliness, and promoting a sense of belonging and autonomy (Fakova, 2020). Foster (1986) describes instrumental passivity as a common occurrence in senior nursing homes in which dependent behaviours of older adults are reinforced. Art therapy can be used as a tool to overcome learned helplessness and instrumental passivity for the older adult population in long-term care facilities.
When working with older adults Camartin (2012) suggests that art therapy focus on increasing communication, validation, reminiscence, stimulation, and the preservation of identity. When working with the aging population, the art therapist will focus on the following goals. The first goal is to help clients foster an internal locus of control. This means to help them control their own emotions, bodies, movements, and materials. Camartin (2012) states that elderly people who live in institutions or hospitals often experience a loss of self-esteem, selfassurance, and integrity due to loss of their independence and self-reliance, and loss of significant relationships. They start to experience the loss of everything that matters to them, often resulting in the feeling that they no longer have any control over their own lives. These feelings of loss can be a catalyst for regression, which is common among the elderly. Therefore, fostering an internal locus of control would help avoid regression because it would give clients a better sense of control over their own lives. Like the first goal, the second goal is to foster selfagency, in whatever way the art process and group can provide the client. This refers to giving 13 the client the sense that some actions are self-generated. The third is to enhance the quality of life, through the art-making process within a group environment which can lead to an enrichment in what quality of life means to the client, accomplished through sensory stimulation and selfexpression. By determining the most effective way of incorporating art interventions, this research will enable future art therapists to implement interventions that are most suitable for older adults based on the loss they are experiencing (Camartin, 2012, p. 7).
Roswiyani (2017) described the quality of life as being a synonym for well-being or psychological health, as it represents a broad range of human experiences related to one’s overall well-being and can be defined by subjective experiences, states, and perceptions (Roswiyani, 2017, 2). Overall, the goal of the art therapist is to provide tools within the group to use in other areas of their lives by integrating the feelings of the clients to accomplish these three main goals. By figuring out the art-based interventions that improve a sense of agency, quality of life and locus of control, an art therapist would best enable an older adult to transition into their difficult phase of life which deals with loss, by giving them a sense of autonomy and control over their lives once more.
Existing Research in Art Therapy
It is predicted that the number of dementia patients will reach 75.6 million by 2030 (Wang, 2016). Most research on dementia that focuses on non-drug interventions has been dominated by psychosocial therapy (Logsdon, 2007). Art therapy can be seen as a branch of psychosocial therapy that combines art with human elements (Wang, 2016). It can be useful to further study the benefits of art therapy for it can provide this population with a non-verbal channel to communicate and help them overcome issues with self-expression that are normally caused by impaired language or physical ability. Most past research conducted with the elderly compared elderly who did art therapy to do who did not participate in art therapy, and has concluded that art therapy was beneficial, yet failed to state the reasons why and the details of which interventions were used. Previous research on the topic has failed to mention the role of the ETC when working with seniors, and those that did mention did not provide enough information on the intervention’s relationship to the ETC (Dunphy et al., 2019).
The Role of Art Therapy
Moosa (2017) found that art therapy is best described as the therapeutic use of art-making within a professional relationship, by people who experience illness, trauma, or challenges in living. Art therapy is thus used as an opportunity to provide for self-expression and introspection (Stephenson, 2006, p. 24). One of the most common reasons for an older adult to seek art therapy is to encourage socialization and thus avoid isolation, which is common to that population, accomplished through group activities (O’Rourke, 2018). The elderly population has expressed a need for creative rehabilitation activities and psychosocial interventions and faces many challenges which as loss of independence and other ends of life issues (Malchiodi, 2012). Art therapy should be used as a method that focuses on the strengths and abilities of older adults to help them review their life and recognize their strengths.
Enhancing Quality of Life in the Elderly
According to Theeke et al. (2015), the prevalence of loneliness in the older adult population is as high as 38% and can cause multiple chronic health conditions. Riggs (2001) states that the rise in dementia is a major concern because the disease will affect 14 million people in the United States by the middle of the century. Alzheimer’s disease and other dementias affect approximately 35.6 million people in the world and can be very costly (Prince, 2013). For example, the annual cost of care related to Alzheimer’s disease in the United States is approximately 100 billion dollars a year (Riggs, 2001, p. 139). The greatest risk factor is advancing age and the risk increases significantly after the 65-year-old (Schaie, 2013). This is an important topic to address because the baby boomer generation will be 65 years old between now and 2030 (Knickman, 2002). Cognitive decline in the elderly can make them a vulnerable at-risk group, as more than half of seniors affected by mild cognitive impairment will deteriorate to dementia. This is statistically higher than the rate for the elderly who are considered of average cognitive capacity (Ehresman, 2014). It can greatly affect their quality of life and result in loneliness because of the isolation that comes with a loss of cognitive functioning. Humans are social creatures; therefore, prolonged feelings of loneliness and isolation can lead to depression in the older adult population (Aarts, 2014). Aarts (2020) defines loneliness as an unpleasant subjective state of sensing a discrepancy between the desired amount of companionship or emotional support and that which is available in the person’s environment. Furthermore, he states that age-related losses such as the loss of working sphere, physical mobility, and loss of 15 loved ones can affect a person’s ability to maintain relationships and independence, which can result in depressive feelings (Aarts, 2020). Loneliness can be triggered due to loss of independence and functional decline and affects 19% of the over 65-year-old population in the US (Theeke et al., 2015, p. 61). Depression is one of the main reasons why older adults enter a long-term care facility, and it can affect up to 30% of older adults above the age of 65 and severely affect their cognitive health (Pike, 2014, p. 23). Older adults that live in a long-term care facility spent 56% of their time doing nothing, which can make them vulnerable to loneliness, boredom, and negative self-esteem (Rosewiyani, 2017).
Snow and D’Amico (2009) address the topic of quality of life by stating that is a broad philosophy that looks at understandings a person’s overall life satisfaction and enjoyment and can be conceptualized and defined in many ways. Its key characteristic consists of the following: general feelings of well-being, feelings of positive social involvement and opportunities to achieve personal potential (Snow & D’Amico, 2009). Quality of life is a concept often used in healthcare, nursing, and rehabilitation, thus a concept often used when working with the elderly (Snow & D’Amico, 2009, p. 258). Creative arts therapies can be used as a tool to determine what is important in people’s lives. Quality of life can also be defined as “an individual’s perception of their position in life in the context of the culture and value system in which they live, it considers their relationship to their goals, expectations, standards and concerns” (Snow & D’Amico, 2009, p. 84). When considering the quality of life, there are two key components which are choice and availability of opportunities for making these choices. When working with disabilities, therapists need to render opportunities that are ideal for personal growth and development.
Psychological Challenges in the Aging Population
Ageing and Loss
The older adult population faces increasing trauma related to loss as they age (Malchiodi, 2012). The loss they experience can be the physical loss of their motor skills or senses, the loss of their autonomy, and loss of control of their life and the loss of a spouse or close friends. Malchiodi (2012, p. 275) states that when working with older individuals’ attention should be given to physical, mental, and emotional abilities that have been compromised by age, bereavement, and the end of a career. Often there is also a loss of their cognitive capacity. 16 Memory loss because of dementia and diseases like Alzheimer’s is one of the main threats for this ageing population. The focus of this research is how to improve the quality of life for seniors who lost their physical or cognitive capacities because of age or dementia. Rusted (2006) states that there has been a growing awareness in the last few years to address the issue of improving the quality of life for people with dementia. There are cognitive and neurobiological deficits associated with dementia such as impaired memory, language and reasoning, and with those come the emergence of depression, anxiety, and personality changes which all can affect the quality of life (Rusted, 2006, p. 517).
Learned Helplessness in the Elderly
Quality of life in seniors is greatly impacted by low self-esteem and negative emotions centering on feelings of learned helplessness. Most past research has failed to examine how art therapy could eliminate feelings of learned helplessness in seniors. Gould (1971) stated that the definition of learned helplessness is an issue affecting the elderly population, and it is not necessarily due to loss of ability. He states that the elderly population suffers from multiple physical and psychological problems which include changing life situations and a reduction in motivation in creative activity (Gould, 2017). These changes result in a downward spiral of lowered self-esteem which could result in depression (Gould, 2017). Gould states that “time becomes virtually an enemy once there is little purposeful activity to fill the house” (Gould, 1971, p. 3). Understanding what causes these feelings of learned helplessness in the elderly would help art therapists select more suitable art-based interventions to counteract these feelings.
Enhancing Cognitive Challenges in the Aging Population
Quality of Life as Center to an Older Adult’s Well-being
Quality of life can be defined as “an individual’s perception of their position in life in the context of the culture and value system in which they live, it considers their relationship to their goals, expectations, standards and concerns” (Snow, 2009). Quality of life is a concept often used in healthcare, nursing, and rehabilitation, thus a concept often used when working with the elderly (Snow & D’Amico, 2009, p. 258). Creative arts therapies can be used as a tool to determine what is important in people’s lives. When considering the quality of life, there are two key components which are choice and availability of opportunities for making these choices. When working with disabilities, therapists need to render opportunities that are 17 ideal for personal growth and development (Snow, 2009). Snow and D’Amico (2009) address the topic of quality of life by stating that is a broad philosophy that looks at understandings a person’s overall life satisfaction and enjoyment and can be conceptualized and defined in many ways. Its key characteristic consists of the following: general feelings of well-being, feelings of positive social involvement and opportunities to achieve personal potential (Snow and D’Amico, 2009).
Cognitive decline in the elderly can make them a vulnerable at-risk group, as more than half of seniors affected by mild cognitive impairment will deteriorate to dementia. This is statistically higher than the rate for the elderly who are considered cognitively normal. Working on a sensory level can help older adults regain lost memories and other vital cognitive functioning. Working with fingerpainting, wet clay or textiles are possible sensory art-based interventions to consider when working with seniors (Malchiodi, 2012). Historically the use of textiles was common to women in which these were culturally relevant material. Generally, engagement with the fiber arts has been shown to boost positive mood, provide a distraction, build self-esteem, increase perceived control and social support (Futterman, 2021).
It is considered part of the sensory component of the ETC (Hinz, 2019). Most art therapy work with the elderly focuses on the sensory component (Hinz, 2019, 34 & 58). The sensory use of art therapy through the manipulation of materials provides older adults with a sense of control within their environment and creates a “tactile connection” to the world (Malchiodi, 2012, p. 280.) Improving older adults’ sense of control over their own life would decrease their feelings of learned helplessness and thus impact their quality of life.
Stimulating Cognition Through Psychotherapy and Art
Mahendran et al. (2018) conducted a study on the elderly with mild cognitive impairment, which is a phase of cognitive decline in which it is still possible to intervene to reverse the decline. In this article using art therapy and cognitive function, it was suggested that cognitive stimulation through psychosocial interventions could improve cognition. The study was conducted on 68 community-living elderly individuals between the ages of 60 to 85 years old with mild cognitive impairment (Mahendran et al.,2018). Art therapy interventions were administered weekly for three months and were divided into two components: The first was a guided viewing of artwork selected by curators from the National Gallery and the University of 18 Singapore Museum; The second component was a visual art production in which the participants had to physically create a themed artwork (Mahendran et al., 2018). This was then followed by an image appreciation activity to gain insight. The study measured neurocognitive capacity, psychological wellbeing, and sleep quality (Mahendran et al., 2018). Each session lasted one hour and included a 5-minute mindful relaxation exercise at the start of the session. The study concluded that there is evidence that specific psychosocial interventions which are both carefully structured and consistently delivered can effectively improve cognitive function for the elderly with mild cognitive impairment. This study revealed that both cognitive evaluation of artworks and the physical creation of art pieces involved different cognitive processes (Mahendran et al., 2018). Therefore, art therapy delivered as a combination of “art-as-therapy” and” art psychotherapy” may have been the catalyst for the process that led to cognitive improvements. However, this study was limited by its small sample size. Therefore, this study focuses on how art interventions’ role in improving quality of life in seniors will explore many past studies to provide a richer sample size. As many past studies lack sample sizes, this one will provide a larger sample size than previous research (Mahendran et al., 2018).
Dementia and Art Therapy
Seifert (1999) studied how individuals with Alzheimer’s type dementia can still learn procedural tasks, facilitated through involvement in art activities. Seifert (1999) observed seniors in a long-term care facility in Ohio for 3 months, twice a week using a quasi-experimental design comparing Alzheimer’s type dementia with non-dementia. Seifert (1999) states that explicit recall of facts can be extremely difficult for individuals with moderate to severe Alzheimer’s type dementia. Sticker placement makes more demands on procedural (implicit) memory than on explicit memory. This study concluded that participants were able to activate meaning in semantic memory and individuals with dementia could retain the skills they learned through creating an image with stickers 3 months later (Seifert, 1999). The results of the research were useful for it suggests that stickers work well with this population.
Safar (2011) studied the effects of dementia in art therapy and determined that the localization of certain brain lesions can affect art production. She states that art production is a complex cognitive, emotional, and sensorimotor process that recruit activity for several brain regions (Safar, 2011). Safar (2011) conducted a case study on a 57-year-old female artist who suffered a decline in her visual-spatial function. This study concluded that different brain areas 19 are involved in the creation of art. A degenerative neurological disorder can affect one’s capacity to make art. Therapeutic interventions may ameliorate the effect of the illness on an individual’s daily life and provide a sense of hope, yet it will not change the neurological course of the illness.
Buren (2013) studied how Alzheimer’s disease changes the painting style of two elderly artists with Alzheimer’s disease, through gradual cognitive decline. He states that conceptual more than formal perceptual attributes are susceptible to change after a neurological illness (Buren, 2013. He emphasized the need for a quantitative instrument to measure changes in art and developed the Assessment of Art Attribute (Buren, 2013). Yong (2015) studied the impact of art-making and art viewing on participants with early dementia and concluded that they have a positive impact on verbal fluency and lifetime memories. Percoskie (2010) states that art allows Alzheimer’s clients to enhance their pride and dignity and minimize their social isolation by increasing interactions with others and help them adjust to a nursing home. Toshimitsu (2000) states that Alzheimer’s disease could cause problems like loneliness and isolation. He suggests art therapy aims to give patients an enjoyable time and provide strong social interactions (Toshimitsu, 2000). The problem this research is attempting to address is how to adapt art-based interventions with the changes in the brain for those affected by dementia.
With what we know from previous research examining art therapy with patients with dementia, which art-based interventions would be more suitable for improving their quality of life? These past studies suggest that interventions should incorporate socialization to minimize social isolation and promote interaction. This research will further explore this by determining which art-based interventions provide social interaction best for this population.
Cognitive Well-Being in Older Adults
Pike (2014) addresses the issue that one day older adults will outnumber younger generations. As stated previously, this will be financially problematic for the younger generation to provide adequate services to meet the needs of the aging population. Pike (2014) states that older adults may come from many different cultural and ethnic backgrounds and that their needs are varied as their cultural practices (Pike, 2014). She argues that older adults achieve cognitive benefits from the enjoyable, stimulating, and social process that is achieved through making art 20 (Pike 2014). She divides an older adult’s cognitive well-being into five key areas which are physical, social, emotional, spiritual, and mental (Pike, 2014).
Pike (2014) states that the brain responds to pain resulting from physical harm in a similar way that it does to the pain that results from social rejection. She addresses the issue of normal and abnormal aging and states that the effects of normal aging do not impede daily living unless triggered by an onset of mild cognitive impairment (MCI; Pike, 2014). Alzheimer’s disease is the most feared of cognitive impairments. MCI is often recognized by language disturbances, attention deficits and deterioration of visuospatial skills (Pike, 2014, p. 21). Alder (2010) stated that depression is one of the main reasons why older adults enter a long-term care facility, and it can affect up to 30% of older adults above the age of 65 and severely affect their cognitive health (Pike, 2014, p. 23). Art making has many benefits for older adults, and it mainly includes aiding communication and providing a point of reference during socialization, increasing discussions with friends and family about their artwork and increase interest and motivation for continued socialization (Pike, 2014, p. 25). Our research focuses on the quality of life of older adults and cognitive well-being is a key component of quality of life, therefore when addressing the issue of improving the quality of life of older adults, one need to consider cognitive well-being.
Howie (2013) suggests that the therapeutic goal should be to emphasize cognitive abilities and social interactions when working with seniors. The art therapist should incorporate themes that aim to evoke memories. It has been proven by Howeir (2013) that body relaxation and guided imagery during the session could be beneficial to the participants.
Art Therapy Interventions
Weaving as Sensory Art
Women generally have a long legacy of using textile handcrafts in the context of social relationships to reduce isolation and reinforce friendships (Collier, 2016, p. 183). For an artmaking activity to be considered effective for well-being, it should include high arousal and engagement, positive mood, and decreased rumination. Complex textiles handcrafts activities, such as preparing to make a new textile project, quilting or weaving were associated with the greatest mood repair and engagement (Collier, 2016, p. 179). Women have historically engaged in textile making for many reasons. Textile handcrafting gave women a sense of place and 21 connected them to their personal histories, enhances their sense of self and collective identity, and for some provides a deeply spiritual or psychological experience (Collier, 2011, p. 104). Women use textile handcrafts because it allows them to calm themselves, to feel centred and to have control over a small part of their lives, to have social opportunities, immerse themselves in the sheer pleasure of the creative process (Collier, 2011, p. 105). Collier (2011) suggested that “Flow” in artistic endeavours is a mental state in which a person is fully engaged in an activity, feels an energized focus, and finds the activity to be intrinsically rewarding. Collier (2011) found that participants who engaged in textile activity showed a greater occurrence of the flow state and experienced a highly focused state, a sense of control and creativity (Collier, 2011, p. 111). The goal of art therapy with older adults has the following objectives: to rediscover interpersonal and intrapersonal meaning in life, to enhance communication with others, to enhance self-esteem and self-worth and to stimulate intellectual, physical, and emotional functioning (Malchiodi, 2012, p. 277). Through weaving, these goals are accomplished, as one can weave a story, socialize as they weave, and sell their weaved projects which can provide them with a sense of fulfillment. Weaving is a tool often used by women in the context of social relationships to reduce isolation and reinforce friendships (Collier, 2016, p. 183).
This is because sensory art experiences do not demand a finished product and thus it reduces the stress of art-based interventions. This reduced stress and increased opportunities for increased confidence which can enhance memory functioning (Hinz, 2019, p. 59).
Puni Making as Sensory Art
Guzman (2011) describes ego integrity as a normal developmental task in Erikson’s (1950) psychological theory for the older adult population (Sneed, 2006). However, he states that the consequences of aging such as loss of physical ability can greatly affect the quality of life, and interactions of older adults and thus impact their quality of life (Guzman, 2011). His study used traditional Filipino art to capture the essence of the lived experience of older adults with physical disabilities: sessions incorporated picture prompting and doodling (Guzman, 2011). He identified 4 activators of ego integrity which are the following: work, family, belief in self and belief in God (Guzman, 2011). This study concluded that the traditional Filipino art of punimaking was beneficial to elderly people with a physical disability because it provided them with a space to share their experiences. Puni means to beautify or decorate with the use of coconut 22 leaves, which are fashioned by folding, plaiting, braiding and simple weaving (Guzman, 2011). Therefore, it is a sensory experience. It can have a functional or aesthetic use.
Clock Drawing as an Art Therapy Assessment
Adlers and Madori (2010) studied the effects of art therapy on the cognitive performance of Latino older adults over 12 weeks. Alders and Madori (2010) stated that cognitive functioning is an essential component for older adults’ autonomy, but when impaired it is correlated with early death. When it is enhanced, it is correlated with a longer and higher quality of life. Cognitive impairment affects 20% of the senior population in the United States. Due to the fact the rate of dementia is higher among Latinos, this study focused mainly on that population Participants were evaluated using the Clock Drawing Test and Cognitive Failures Questionnaire. The study concluded that participants who attended the art therapy sessions outperformed those who did not on both cognitive evaluations. The study by Alders and Madori (2010) concludes that attending art therapy sessions is more beneficial for enhancing visual motor skills and visual-spatial abilities. The study was limited because the experimental and control groups were self-selected and there is a possibility of experimenter bias as participants were selected based on language. This limitation in past studies will not be a limitation for this current study, as this study looks at many previous studies and therefore experimental and control groups could not be self-selected and there is no experimenter bias (Alders & Madori, 2010).
Cultural-Based Interventions with Older Adults
An older adult who originally immigrated from another country may experience even more loneliness, due to language isolation from being part of a different culture or speaking a different language. Art therapy caters to the needs of these older adults as well. Lineseh et al. (2014) address the role of art therapy with acculturation and immigration. Immigrants often suffer from a loss of identity and a feeling of exclusion. These feelings of loss are like the loss of identity and isolation that greatly affects the aging population. Art therapy plays a role in contributing to successful adaptation and acculturation experiences by enabling a narrative of them. The sessions provided an open-ended art experience for the expression and sharing of immigration and acculturation stories. Participants in this study valued the art process for its ability to help expand the expression of feelings (Lineseh et al., 2014).
Moosa (2017) suggests that when doing art therapy with refugees it should focus on a solution-based approach. Art therapy with refugee or immigrant clients can provide them with a needed feeling of structure, a sense of control, a way to re-assert their identities through emotional expression (Moosa, 2017). It is an effective tool for improving mood and socialization. Solution-focused art therapy calls for creating hypothetical goals that include desired behaviours to help clients see what is possible for them. Art that involves storytelling has proven most successful. Moosa (2007) conducted a study of 3 weeks on refugee children in India using this approach to art therapy. The study concluded that solution-focused art therapy can reduce emotional disturbances in refugee children (Moosa 2007). When addressing the issue of how to improve quality of life in seniors, Moosa’s (2017) research suggested that perhaps interventions that look at storytelling or reasserting self-identity would be beneficial to our target population.
Overall, the literature on art therapy when applied to the older adult population and the challenges they face, proved that art therapy is beneficial. Art therapy enables a narrative and fosters socialization and helps promote a sense of self-worth and identity. It is essential to improving the quality of life of this population.
This research study examines the benefits of art therapy interventions to counteract the struggles on the aging population's quality of life in nursing homes. The following research question will be examined through the theoretical framework: Do art therapy interventions in a friendly safe environment contribute to an increased quality of life for seniors who suffer from isolation due to dementia or living in a nursing home? Art therapy has proven beneficial to this population that is suffering from loneliness, depression, isolation, and loss of autonomy. Past research has shown that art interventions are beneficial in counteracting these issues. However, few pieces of research suggest which art intervention would be best to improve the quality of life in the aging population.
The Arts-Based Research Approach
Art-based research is defined by Kapitan (2011, p. 212) as the creation of knowledge using artistic means within a research perspective. It emphasizes the making of artistic forms and 24 their expressive qualities to call forth, understand, and examine experiences that cannot be articulated by traditional means (McNiff, 2008). It is often applied to art therapy for direct engagement in art and becomes the "site" for investigating research problems through direct perceptual evidence. The advantage to the research is that it opens a new perspective onto the client or population through an artist-researcher relationship (Kapitan, 2011). The arts-based research approach aims to create meaning from experience, which in turn encourages the development of new perspectives on the data (Finley, 2008; Simons & McCormack, 2007).
The Theoretical Framework
For this research study, the method that was chosen was to do an integrative review of the research topic through a theoretical framework while also conducting art responses with the art-based approach that will explore feelings experienced by the elderly through art interventions. This method was chosen for various reasons, the main reason being to provide a deeper knowledge of the subject being examined in this study. The purpose of a theoretical approach is to focus on an intervention's efficacy (Kapitan, 2011). Thus, the goal of this research was to find the best interventions for the aging population. In theoretical research, the researcher searches for all potentially relevant reports on treatment and eliminates those that do not meet certain eligibility criteria for the rigor. It also evaluates the remaining studies and synthesis their collective findings. For this research, the researcher has searched for relevant data from 1990 to 2020 from various databases such as PsycINFO, Google Scholar, EBSCO, and ProQuest.
When reflecting on why this study's chosen method is appropriate to answer this research question, there are many elements to consider. The field of art therapy continues to expand on research on investigations of the benefits of art therapy interventions. However, the field appears to lack sound scientific investigation that tests the efficacy of most of the art therapy interventions currently used in the field (Huet, 2015). Since the field lacks sound research, it resulted in the issue that there is limited evidence for the efficacy of art therapy interventions.
The theoretical approach combines techniques and practices from various theoretical orientations (Arkowitz, 1997). It is an approach that examines areas of convergence between different therapies and proposes that combining them can lead to more effective treatments. The goal is for art therapy researchers working in the field today to gain fresh insight from examining past experiences. The theoretical framework for art therapy research is like a blueprint of 25 knowledge that helps lead to a better understanding of the field of art therapy. The theoretical framework is considered by Grant (2014) to be one of the most important parts of the research process. She describes it as "the foundation from which all knowledge is constructed for a research study." It has many functions in the research process, as it serves as the structure and support for the rationale of the study, the purpose, the significance, and the research question. It provides the anchor for the literature review and methods and analysis. It is a guide on which research builds and supports their study by providing the structure to define how to approach the research overall. Eisenhart (1991, p. 205) defines theoretical research as a "structure that guides research by relying on a formal theory which is contracture by using an established, coherent explanation of certain phenomena and relationships."
By conducting this research, many advantages will be offered to the field of art therapy. Firstly, it will provide a better understanding of the elderly population and how art therapy could be employed to improve their quality of life. The researcher has recently worked with this population, but this population's work was prematurely terminated due to the COVID-19. This worldwide situation greatly targets the elderly population; therefore, their quality of life is severely threatened. Finding better ways of conducting art therapy with this population would bring them more joy, purpose and less isolation in these difficult times.
The theoretical framework and literature review are remarkably similar and can be considered intrinsically linked. Grant (2016) states that the theoretical framework could be used to logically develop and understand the different and interconnected elements of the literature review. Both can be developed harmoniously and used to support the data, interpret the findings and draw conclusions. Writing a theoretical review in a research study has the advantage of helping define concepts, review theories, review evidence and analyze methodological issues for the topic being addressed in the research study (Broome, 1993).
Kapitan (2011) described a systematic review as the top of the evidence hierarchy, not only to identify efficacy and promote evidence-based practices but also useful to justify the use of services. She describes the various steps of a systematic review, which are the steps that this research will follow (Kapitan, 2011). The first step by Kapitan (2011) is to frame the problem, purpose, and scope of a review. This will center around the research question mentioned before. The second step by Kapitan (2011) is to conduct an exhaustive search of the research literature. This step requires locating earlier research to build the current research. Generally, the search is 26 conducted using journal articles found in several databases and surfing the internet. The third step by Kapitan (2011) is the data assessment. This entitles that once the search process is completed, the researcher will screen for classifying articles by their type and source, and they will select only the articles whose studies are most relevant to the researcher question. Kapitan (2011) states the fourth step is to analyze the data and develop a synthesis. The final step is to present the results of the systematic review (Kapitan, 2011). When considering which kinds of data will be collected with this method, which uses a theoretical approach, the researcher will focus primarily on data that represents the quality-of-life measures. Other data that will be collected in this research would be studies on case studies that examined the above-mentioned variables: quality of life. The study has looked at different types of art therapy interventions that were used in an art therapy setting with the aging population, focusing primarily on older adults living in a nursing home setting or older adults with dementia, which greatly affects the quality of life. The main variable being studied, therefore, is the quality of life.
This research has incorporated the researcher's art response when working with the population that this research attempted to help with more insight into how art therapy can help their quality of life. The research has incorporated the researcher's art response as part of the overall art-based research. Its main advantage is to help the researcher by providing a contained space for reflecting on countertransference (Gibson, 2018, p. 99).
Art responses such as visual journaling can be an idle means for reflecting on countertransference. This research will incorporate a visual journal of my time during the pandemic, reflecting on how feelings during the 2020 pandemic could be like the feelings experienced by the elderly population. Response art is best described as a conscious act of art making used by art therapists in response to client experiences. In the case of this research, the art responses have been used to help the researcher express and examine their reactions and share their reflections with others (Gibson, 2018).
Moon (2000) argues that art response allows an art therapist to understand and be present with his clients through art making. Art responses can follow themes that relate to the client's emotional needs or trauma, which helps the research connect with the population (Gibson, 2018). 27).
Art responses are a critical way to making progress in treatment (Miller, 2007). If art responses can help the treatment process, it makes sense to assume it would also help the researcher determine which course of treatment is most advantageous to our target population. Miller (2007) argued that the main advantage of using art responses is to better comprehend the role and utilization of countertransference. Response art can also serve as a means for selfsoothing. Miller (2007) defined response art as the therapist's manipulation of the use of art materials in response to the client in session or as a means of processing feelings and reactions post-session. In the case of this research, the art response will be used as a mirror of the researcher's process of working with her clients. Miller (2007) argues that art responses serve as an immediate outlet for the release of emotions, frustrations or identification that were stirred up during the session. It is also used as a tool for learning and self-inquiry. Response art serves as a concrete method to help the researcher explore their feelings outside the session.
In this art-based research, response art will help the research manage and understand their work with the population being studied. Fish (2009) described art responses as art that is made to contain, explore, and express clinical work. It is also used as data to inform and be used as the synthesis of art-based research. It allows art therapists an opportunity for important introspection. "By maintaining the artist's creative lens, practitioners can conceptualize treatment, imagine possibilities and recognize the potential for resilience and change." While traditional quantitative and qualitative methods of conducting research can be cold and distancing, art response allows the researchers to truly connect with their clients and activate their own deeper understanding. To conclude, art response was chosen as a method for this research because it will help the researcher support empathetic engagement with clients, illuminated the researcher on countertransference and offer an opportunity for personal growth (Fish, 2012).
Stages of Arts-Based Inquiry
This framework aims to inform how art can assume its potential as a creative and critical form of human inquiry, agency, and production (Sullivan, 2010, p. 99). Its methods are rigorous yet flexible as they are open to change and unanticipated outcomes (Kapitan, 2011). The research was conducted from the first day of the pandemic, March 13, 2020, to April 13, 2021, during the 28 COVID-19 lockdown. The researcher examined the relationship with the elderly and herself as the researcher, through the creation of art responses 3 hours per day of art making inspired by the literature. Looking at the literature the researcher reflected on her feelings, spontaneous art journaling and documenting the process with photography. In this research, the researcher has applied the five stages described in Kapitan (2011).
For this research, the researcher has conducted several art responses using fibres and textiles with the crochet technique and weaving. The art would be inspired by a technique often used with the elderly. The art response aims to help the researcher slow down and be more attentive towards the self. The process was to examine the themes unveiled in this research as they relate to the ETC. The researcher also explored art responses through painting birdhouses, rocks, flowerpots, and drawing.
1. Initial awareness: When it comes to creating an artwork, the researcher's idea is singled out from its original context for its aesthetic value and thus is worth exploring further. Initial awareness was attained from practicum experience, literature review, reading on the themes and gathering art materials. Kapitan (2011) states that the researcher's relational position toward their idea, research purpose or artwork is established at the onset. I looked on the research that was previously conducted on the literature review for the common themes. I gathered art materials that were available which was challenging with many art stores closed during the lockdown.
2. Decontextualization and intentional re-creation: The research takes an image or idea and further explores it by re-creating it in an artistic medium while working with the research intention in mind. This state is important for opening what the researcher does not know; this will later challenge what we want to know (Sullivan, 2010). This step of the research was conducted by my journaling which I used to reflect on my feelings of countertransference through response art. This research created mainly artworks using wool, which is a medium often used by the elderly population. It is composed mostly of hats, slippers, socks, and other weaves. The research was inspired by the researcher’s time in her practicum, watching elderly women weave and create hats. The research also incorporated traditional techniques such as paintings on various surfaces such as birdhouses, rocks, flowerpots, and wood projects. Other traditional art techniques such as drawing was also used. 29
3. Appreciation and discrimination: The artworks created are adjusted and transformed while discriminating assessment continues in a cyclical process until completion is obtained at the satisfaction of the artist-researcher. In this stage, the artist-researcher then revaluates the re-created artwork for its value or effective expression. In this section, I took photographs of the art-making process, particularly the final artwork and those photographs lead to more art making.
4. Refinement and transformation: At this stage, the artwork is shared with others and can be refined and analyzed. The artwork was then shared through social media and the researcher’s website with other art therapists and family members.
5. Re-contextualization: The artworks will be presented through the research findings.
Ethical Considerations and Biases
Ethical considerations examined in this research include being aware of the boundaries of my role as a student intern and my role as a researcher. Ethical considerations were also made towards sharing my photographs on social media, with the goal of educating through my artistic inquiry. Arts-based inquiry serves to promote aesthetic, experiential, and emergent meanings and used to reflect on metaphor, symbols, and meaning (Brown, 2008).
When working as an art therapist with senior client's suffering from cognitive loss, many ethical considerations need to be addressed. According to McGuire (2009), when working with older adults, a therapist should consider evaluating each person's level of vulnerability. He stated that situations that can increase vulnerability in the older population may include chronic or disabling disease, loneliness, and lack of financial means to access proper healthcare. According to the APA ethics code, a therapist should refrain from age-related bias (American Psychological Association, 2017). McGuire (2009) described the term "ageism" as prejudice toward, stereotyping of or discrimination against people who are defined as old (APA, 2003, p. 239). An example of this would be assuming an older adult need to rest, and therefore not encourage physical or mental activity. Therapists may also fail to address sexuality with this population because of the misconception that seniors do not participate in intimate relationships. What if the participant's cognitive impairment does not allow them to provide informed consent, because they are affected by severe cognitive decline resulting from dementia or Alzheimer's? In this situation, the therapist must determine how much the client is willing to participate in the intervention (McGuire, 2009). Informed consent is required to exhibit artworks. Consent can be 30 obtained by asking participants to restate the purpose of the study in their own words (APA, 2003).
Data Collection Procedures
Data gathering in the art-based research approach follows the usual ways that an artist works: starting with visualizing, sensing, intuiting, focusing, reasoning, questioning, grounding, comparing, and interpreting (Kapitan, 2011). This research explored the struggles often faced by the elderly population when creating art and investigating the themes of loss, self-esteem, and control over one's life through the weaving process. Therefore, I crocheted 50 hats of different sizes and styles, crocheted 10 sock slippers, painted 10 flowerpots, painted 5 rocks, painted 15 birdhouses and 5 other wood projects whilst also working on a visual journal through drawing and photography.
The artist-researcher reflected on her experience working with the elderly at Saint Margaret's and used art techniques typically used by the elderly to attempt to better understand how these techniques can be soothing for the elderly by further understanding their perspective using the material.
Data Analysis Procedures
The forms produced, mainly the hats and painted birdhouses guide and verify experience, but also would require interpretation to illuminate for others the meanings and understandings they contain. In art-based research, data analysis is carried out via interpretive art responses and frameworks that evoke and amplify meanings aesthetically (Kapitan, 2011, p. 223). This is accomplished through three simultaneous tasks: to reduce the data in a crucial way by sorting, filtering, or coding. To display the data using an organized visual format as to provide an overview and understanding of the whole by linking and seeing relationships, and finally to draw conclusions by asking questions related to patterns, themes, and relationships as well as concepts and perceptions that can apply to meaning (Kapitan, 2011). For this research I explored the challenges and feelings often experienced by older adults by engaging in some art making by creating the interventions that are linked to what was learned in the literature review about suitable interventions for the elderly. These interventions focused on storytelling, sensory art, and the creation of practical artwork.
The Birdhouse Art Responses
Unpainted Wooden Houses
Painting birdhouses is a creative activity that requires focus for long periods. Its main benefits are that it is an activity that provides a purpose. In this case, the purpose is to create a beautifully decorated home for another form of life. This serves the aging population because older adults often feel they lost their purpose due to loss of physical or cognitive ability. By painting birdhouses, it gives them a feeling of purpose throughout the activity. The birdhouses are a metaphor of home. I started working with the birdhouses to explore the metaphor of a safe space and home.
Wooden birdhouses were first used in the open studio of Princeton House Behavioural Health partial hospitalization program in Princeton, New Jersey and were first implemented by Jill Gardener, an art therapist (Buchalter, 2009).
This activity has been proven to be enjoyable to older adults, especially men who are often reluctant to take part in art. Men who often have experience in woodworking can build or modify a birdhouse. When conducted with seniors, this activity would use an already made birdhouse, but it can be sanded, modified, and painted. This activity helps maintain dexterity and promotes mindfulness.
The creation of whimsical birdhouses to decorate gardens was explored as an art response for this research. Watching birds is therapeutic as it can allow patients a window into the world of nature. Birdwatching is popular with seniors who are often confined to their rooms and whose only connection to the outside world is sometimes the view from their windows. Through the creation of a home for birds, who mainly symbolize freedom with their ability to roam the earth and soar the skies, seniors regain a connection with the sense of freedom they once had. Birds are also a symbol of life, rebirth, peace, hope, and love.
During the 2020 pandemic, which occurred at the start of the spring, I decided that because I was trapped in my home, and since I had lost my two jobs and my university classes were cancelled, I would have to find a productive use for my time.
The emotions I experienced in the early days of the pandemic are remarkably like the emotions many older adults feel, especially those who experienced a loss of cognitive or motor ability. Many seniors, who no longer work their professions due to issues related to aging, tend 32 to experience a loss of a sense of purpose. This can cause feelings of depression which greatly affects this population. I, too, felt suddenly useless in society. The quarantine also caused a great deal of social isolation, as I could no longer see my coworkers, friends, or family. I began to reflect on how these feelings of being socially isolated are also common to the aging population, whose friends had died or whose children abandon them.
I decided to create artwork that would explore these feelings, restore a sense of purpose to my life, and lower my sense of loss. I purchased some birdhouses from the local art stores, and constructed birdhouses from wood pieces I found in an old pile of art supplies in my closet. With acrylic paint, I would decorate the birdhouses with different motifs and themes. Many of the symbols used were symbols of life, existence, and quarantine. For example, I used the rainbow, a popular symbol of hope and optimism in the 2020 pandemic. It was popular for children in Montreal to decorate the windows of their homes with this symbol of hope. The concept of a "rainbow after a storm" was behind this symbol. The phrase "Ça va bien aller" and "Things will get better" started to surface on the windows of residents and businesses all over the city of Montreal. However, this phrase originated in Italy, which was one of the countries hit hardest by the COVID-19 pandemic.
Another example of trying to maintain optimism and positivity in these difficult times is the use of bright colours on the birdhouses. The idea behind it is to bring more positivity to my garden, which during the pandemic of 2020 was my only connection to the outside world beyond my house. I would spend countless hours gardening and watching the birds in my garden, and I wanted to contribute to it by making it more decorative, brighter, and positive. For the outside world was becoming darker due to people worrying about catching COVID 19, I wanted my only sanctuary to become a symbol of positivity in these dark times.
Colourful Nature Symbolism Birdhouses
Perceptually Colourful Bird Feeder
Pandemic Hope Symbolic Birdhouse
Pandemic Hope Symbolic Birdhouse
Emotional Symbolic Birdhouse
Existential Universe Symbolic Birdhouse
Colourful Birdhouses with Purpose
Painted Rocks Art Response
I spent months in my garden because it was the only space I could visit for most of the spring and summer due to the COVID-19 crisis. I started collecting rocks and had this idea to paint them with themes that reflected my feelings towards the COVID-19 crisis. I also tried relating my feelings to those feelings experienced by the elderly when living in residence. The rocks were my canvases provided by the natural world. I would paint the rocks with acrylic paints and then cover them with wood varnish so the paints would resist the natural elements outdoors.
Ladybug Rock Painting
The first rock I painted was an image of a ladybug which symbolizes the importance of lightness. It is also a symbol of luck. When reflecting on the COVID-19 situation, I felt very 36 lucky to have a good home and family with which to spend the quarantine time with. I realized that many elderly people are alone during this difficult time.
Caterpillar Rock Painting
The second rock painting was an image of a caterpillar, a symbol for patience and transformation. Like the caterpillar that has to change with time, I too had to learn to change due to the COVID-19 situation. I went from a very busy schedule, working nearly every day without a break, to having time to reflect on life and devote myself to self-care. Both the ladybug and caterpillar rocks were placed in my garden's plant pots to watch over my plants.
Mask Self-Portrait Rock Painting
The third rock painting was a self-portrait of myself during the COVID-19 crisis. In this portrait, I painted myself wearing a mask, and there is the COVID-19 symbol in the background. The elderly often feel that the world no longer sees their utility and thus, they often feel invisible. 37 I had the same feeling when wearing a mask. I was obliged to wear the mask everywhere I went and people couldn't see my face, which often left me with a feeling of not being seen for myself. I often felt invisible, as to properly communicate with others I needed people to see my smile and face. I could relate to the feeling of not being seen for the person I am, a feeling often experienced by the elderly who reside in nursing homes, those without loved ones who feel neglected by society.
The fourth rock painting depicted ocean scenery. While I was stuck in my home for months, I often imagined this scenery, so I feel most free when near nature and the ocean. I imagined the lighthouses of Gaspesie, where I dreamt of visiting to escape from the quarantine back home. I wanted to go somewhere where I was not restrained by rules that controlled my daily life. I imagined this feeling to be similar to an elderly person living in a nursing home, who often looks outside their window to imagine the freedom and nature beyond the nursing home walls, dreaming for the freedom they once had.
Ocean Voyage Rock Painting
Painted Flower Pots Art Response
Another art-based response for this research project was painting plant pots. The idea was to beautify my garden as it was where I spent most of my quarantine. I would purchase flower pots and then paint them with acrylic paints. They became the containers that would hold new life. For me, it was a symbol of hope in these difficult times. The first one I painted was an image of a cardinal.
The cardinal represents devotion and loving relationships. This is a very important theme when reflecting on the population on which this research focuses. Seniors are often neglected and most experience the loss of important relationships, such as the loss of a spouse. During the time of the COVID-19 crisis, I realized how important relationships with family and romantic partners can be when trying to cope with difficult times. I was grateful to have the support of my 38 loving boyfriend and the assistance of my family. However, being cut off from my friends due to social distancing rules was very difficult and resulted in feelings of great isolation and loneliness. Those feelings are often experienced by the elderly. The other flower pots I painted featured nature symbols, for the feelings I felt for most of the quarantine were to reconnect with nature. A flowerpot contains a seed that would bring new life to my garden, and this had me reflect greatly on the cycle of life. I would often think of the elderly as towards the end of the life cycle, but they are the containers carrying new life like the flower pots. For the young would not exist without the old that brought them to this world. The elderly often provide the young with valuable knowledge and thus provide them with a better world.
Cardinal and Sunflower Flower Pot
Insect Symbolism Flower Pots
Journalling in Isolation
Storytelling through journaling was another art therapy intervention I explored. When reflecting on my feelings of isolation during the pandemic, I illustrated by daily routine of how I felt and coped with isolation. I did an illustration of myself alone in my garden with the birdhouses I created drinking a cup of coffee. This type of journaling of my daily routine, helped me express my feelings through visual imagery and tell the story of how I coped with isolation. This helped me further my understanding of how an elderly person could use drawing tools to express how they feel throughout their daily routine.
A Day in Quarantine
Feelings of a World Falling Apart
When reflecting on the feelings often experienced by seniors on losing control over their motor and cognitive ability, I created a drawing of what I felt would best visually represent losing control.
Painted Wood Projects
I explored the art intervention of functional art with a purpose to further my understanding of appropriate art interventions to use with seniors. Painting artwork with a purpose such as a sign or a Christmas nutcracker felt me feel useful because the object created would serve a purpose. This relates to the population being studied because when an elderly person who has lost their sense of purpose is able to create something useful, not only those artworks created serves a utility but that person who created also regains a sense of purpose.
A Sign with a Purpose
Circle Loom Art Response
The repetition of weaving and crocheting on a circular loom, also helped seniors regain a sense of utility and purpose. I explored this art intervention, by learning how to weave on a circle loom, a technique I learned by observing an elderly woman create a hat at the Saint-Margaret’s day program. I was inspired to try for myself, and created several useful objects such as hats, socks, and slippers. I felt a sense of utility knowing I created something that could be worn by another person. It restored a sense of community. By creating hats for babies and children, I realized that an older adult who creates clothing with a circular loom could connect intergenerationally by aiding to bring warmth and comfort to the younger generations. This type of intervention is cognitively suited to an elderly person whose cognitive abilities are declining, for it implies the use of repetitive motion.
Symbolic Bumblebee hat
The Process of Repetition on a Circle Loom
Crochet Children Hats
The Pandemic Hats
Corking Process on Small Circle Loom
Weaved Socks on a Sock Loom
Newborn Hat and Socks
Weaved Hand Bags
Weaving with Nature and Sticks
The process of weaving also involves the use of repetitive motion. When weaving on a traditional loom, I found that the process of repeating the over and under motion to be very relaxing on my mind. The more I weaved, the more my mind felt less cognitive stress and more relaxed. The more I engaged in weaving the more I felt happy. The weaves were not complex and it was easy to use with low motor skills, which I felt would be a pleasant activity for seniors who which to learn the technique for the first time. It felt very soothing to create the weaves using the repetitive movements.
Plain Weave on Sticks
Plain Weave using Branch
The Scribble Drawing
The scribble technique can be used to encourage the spontaneous expression and to capitalize on projections when a client may find verbal communication difficult (Malchiodi, 2005). Scribble drawings were first explored by Florence Cane (1951), who was interested in initiating the creative process. The left brain deals with the verbal dialogue and the right brain the nonverbal conversation in the therapeutic process (Schore, 2014). The scribble drawing works both sides of the brain as the client identifies the symbols, images, and metaphors in their drawing, and these in turn foster verbal expression and dialogue between the client and the therapist (McNamee, 2004). In this artwork, I began with a simple scribble drawing and reflected on what feelings an older adult would be experiencing during the time of the pandemic. The scribble reveled images of masks and the virus. It helped me reflect on the feelings of fear.
Covid Scribble Drawing
My initial question on how art therapy could be beneficial to the aging population dealing with loss explored which art interventions were most suitable to meet the needs of this population. The study evolved further into exploring which ETC level most advantageous and why. The past literature has pointed in the direction of sensory art that challenges the cognition and that the primary goal of art interventions with this population was to improve quality of life. This evolved the study further when engaging in art responses that aimed to restore a feeling of 47 purpose during the pandemic when most people had lost their sense of purpose. Like the older adults in this target population, the researcher engaged in art making that centered in restoring a feeling of utility to increase quality of life and happiness. The researchers experience with the process of art making allowed her to connect to feelings of isolation experienced by the aging population, and the art itself gave her a feeling of restored purpose in a time when the researcher felt idle and useless, being isolated home during the pandemic. The researcher reflected on these feelings of idleness and gained a better understanding of how art making can restore a feeling of utility to one’s life.
The literature looked at how to increase the quality of life of the aging population particularly those with dementia, however the study evolved to focus on the overall feelings of loss associated with the process of aging and to relate those feelings to the ones associated with the pandemic, which greatly affects the aging population. The researcher gained a greater understanding of how art interventions could restore a feeling a utility and bring back purpose to one’s life, which is something the elderly population would benefit from to increase their quality of life. This was accomplished through the art responses in this research by painting birdhouses which brought a sense a purpose, as one would be brought not only beauty to the garden but also a home to birds. Another example from this research was exploring the cycle of life, in which the researcher engaged in crochet projects using a loom to create clothing and objects that could be used with other generations, promoting the feeling that the elderly population serve a function in the cycle of life through creating art that would be used by other generations.
Why is More Research in Art Therapy Needed?
This study has examined how past research involving art therapy with the elderly has contributed to further understanding of which interventions would be best applied to improving their quality of life. For example, in terms of the ETC which component would be most advantageous to this population and why? There is a need for more research about art therapy with the older adult population, and how sensory art and perceptual art could be advantageous to meet the needs to help cope with feelings of loss related to aging.
The main limitation of this study was the timeframe: as the researcher I had to balance my career as a student intern in art therapy with the deadline to submit the research. The 48 response art was centered on weaving, which was very time consuming. I would have liked to have more time to create even more art responses to further experience the feelings associated with making art. This research was also greatly affected by the pandemic which had a negative effect on the researcher’s mood facing the difficulties of losing jobs due to the pandemic and experience social isolation and limitations of freedoms once had. The researcher had to cope with loss of work due to the pandemic, loss of freedom due to the COVID restrictions, a decline in mood, and the depression of loved ones due to the pandemic. The research also had limited resources as she was working from home and no longer on campus. Art materials were also limited due to many stores being closed due to the pandemic, therefore the researcher had to use materials she already owned or order them online.
This research project aimed to provide further insight on which art interventions would be best to improve the quality of life in the aging population. Further studies should focus more on response art to better understand the aging population. It is recommended that all art therapist working with a population of older adults engage in the creation of art responses, to allow them to become more attuned with the needs of the populations by allowing them to understand the barriers and feelings they experience. Based on the experience of this research, an increase timeframe would suit any research that involves the creation of art responses, as art making is a time-consuming endeavor.
Quality of life for older adults is threatened by loss of autonomy, cognitive capacity, and motor ability which can lead to depression and isolation especially since COVID-19 which makes this population very vulnerable. Art therapy could serve as a tool to eliminate the negative feelings of loss that has been greatly increased by this population during the pandemic.
Aging affects us all, and it is important to understand the most suitable ways to cope with the losses associated with it, and that is where art therapy serves a vital role. This theoretical research that incorporated an arts-based approach examined whether art therapy interventions in a safe environment contribute to an increased quality of life for seniors who suffer from isolation because of dementia or living in a nursing home? This was accomplished by the research art responses through journaling, weaving, painting, and photography. 49.
To conclude, this study has examined previous research on which art interventions are most suitable to the aging population, and it has mainly examined how sensory art is the most beneficial to the aging population, particularly a population of older women (Howie, 2013). Therapeutic goal should be to emphasize cognitive abilities and social interactions when working with seniors, and weaving and the manipulation of textiles such as yarn has been established as a successful intervention for challenging the cognitive capacities of seniors while also providing them with social interactions while participating in the activity in groups (Howie, 2013).
Collier (2016) has described that complex textiles handcrafts activities, such as preparing to make a new textile project, quilting or weaving were associated with the greatest mood repair and engagement. Through the art responses of weaving the researcher concludes that this is indeed true, as the process of weaving and creating with wool gave an increase in one’s sense of usefulness, and helped increase relaxation of the mind and reduce anxiety. Sharing the process of weaving on social media and the researcher’s website also reduced the feelings of isolation.
As Hinz (2019) stated, sensory art experiences do not demand a finished product and thus it reduces the stress of art-based interventions. This reduced stress and increased opportunities for increased confidence which can enhance memory functioning. Weaving and other art interventions provide seniors with a space to share their experience and contribute to an increase in quality of life.
This art-based research has examined the feelings of loss that many older adults face due to the process of aging and has done so by the researcher’s creation of various art works. After examining the feelings that each art intervention has brought, the researcher concludes that art interventions are indeed beneficial to the aging population.
American Psychological Association (2017). Ethical principles of psychologists and code of conduct. https://www.apa.org/ethics/code/
American Psychological Association (1987). Casebook on ethical principles of psychologists. American Psychological Association.
American Psychological Association. (2003). Guidelines for psychological practice with older adults. American Psychologist, 59, 236-260.
Alders, A., & Levine-Madori, L. (2010). The effects of art therapy on cognitive performance of Hispanic/ Latino older adults. Art Therapy: Journal of the American Art Therapy Association, 27(3), 127-135.
Adlers, A. & Madori, L. (2010). The effect of art therapy on cognitive performance of Hispanic/ Latino older adults. Journal of the American Art Therapy Association, 27(3), 127-135. DOI: 10.1080/07421656.2010.10129661.
Aarts., N., Noordam, R., Hofman,. A., Tiemeier, H., Stricker, B.H., & Visser, L.E. (2020). Utilization patterns of antidepressants between 1991 and 2011 in a population-based cohort of middle-aged and elderly. European Psychiatry, 26(6), 365-370. DOI: https://doi.org/10.1016/j.eurpsy.2014.02.001
Arkowitz, H. (1997). Integrative theories of therapy. In P. L. Wachtel, S. B. Messer, P. L. Wachtel, S. B. Messer (Eds.), Theories of psychotherapy: Origins and evolution (pp. 227-288). Washington, DC, U.S.: American Psychological Association.
Bamford, C., Lamont, S., Eccles, M., Robinson, L., May, C., & Bond, J. (2004). Disclosing a diagnosis of Dementia and the probable senile dementia of the Alzheimer type in the Framingham Study, Neurology, 42, 115-142.
Beard, R (2011). Art therapies and dementia care: a systematic review. Dementia, 11(5), 833- 656.
Buren, B., Bromberger, B., Miller, B., Chatterjee, A., & Potts, D. (2013). Changes in painting styles of two artists with Alzheimer's disease. Psychology of Aesthetics, Creativity, and the Arts 7(1), 89-94.
Broome M. E. (1993). Integrative literature reviews for the development of concepts. In Concept Development in Nursing, 2nd ed (Rodgers B.L. & Knafl K.A., eds),
W. B. Saunders Co.,Philadelphia, PA, pp. 231–250. 51 Brown, C. (2008). The importance of making art for the creative arts therapist: An artistic inquiry. The Arts in Psychotherapy, 35(3), 201-208.
Buchalter, S. I. (2009). Art therapy techniques and applications. London: Jessica Kingsley. Cane, F. (1951). The artist in each of us. Pantheon Books.
Camartin, K. (2012) The Use of Art Therapy with Persons with Dementia. Canadian Art Therapy Association Journal 25(2), 7-15.
Ciasca, E., Ferreira, R., Santana, C., Forlen O., Santos, G., Brum, P., & Nunes, P. (2018). Art therapy as an adjuvant treatment for depression in elderly women: a randomized controlled trial. Revista Brasileira de Psiquiatria, 40, 256-263.
Collier, A., Wayment, H., & Birkett, M. (2016). Impact of making textile handcrafts on mood enhancement and inflammatory immune changes. Journal of the American Art Therapy Association, 33(4), 178-185. DOI: https://doi.org/10.1080/07421656.2016.1226647
Collier, Ann. (2011). The well-being of women who create with textiles: implications for art therapy. Journal of the American Art Therapy Association, 28(3), 104-112, DOI: DOI: 10.1080/07421656.2011.597025
Dewing, J. (2002). From ritual to relationship: a person-centered approach to consent in qualitative research with older people who have dementia. Dementia, 1(2), 157-171
Dunphy, K., Baker, F. A., Dumaresq, E., Carroll-Haskins, K., Eickholt, J., Ercole, M., Kaimal, G., Meyer, K., Sajnani, N., Shamir, O. Y., & Wosch, T. (2019). Creative Arts Interventions to Address Depression in Older Adults: A Systematic Review of Outcomes, Processes, and Mechanisms. Frontiers in psychology, 9, 2655. https://doi.org/10.3389/fpsyg.2018.02655
Eekelaar, C., & Camic, P. (2012). Art galleries, episodic memory and verbal fluency in dementia an explorative study. Psychology of Aesthethics, Creativity, and the Arts, 6(3), 262-272.
Ethical principles for art therapists (2017).American Art Therapy Association. Retrieved form https://arttherapy.org/ethics/
Fakoya, O.A., McCorry, N.K. & Donnelly, M (2020). Loneliness and social isolation interventions for older adults: a scoping review of reviews. BMC Public Health (20) 129 https://doi.org/10.1186/s12889-020-8251-6 52
Finley, S. (2008). Arts-Based Research. In J.G. Knowles & A. L. Cole (Eds.). Handbook of the arts in qualitative research: Perspectives, methodologies, examples, and issues. Thousand Oaks, CA: Sage Publications.
Fish, B. (2019). Response art in art therapy: Historical and contemporary overview. Journal of the American Art Therapy Association, 36(3), 122-132. DOI:10.1080/07421656.2019.1648915
Fish, B. (2012). Response art: The art of the art therapist. Journal of the American Art Therapy Association, 29(3), 138-143, DOI: 10.1080/07421656.2012.701594
Foster, P.M. (Ed.). (1986). Therapeutic Activities with the Impaired Elderly (1st ed.). Routledge. https://doi.org/10.4324/9781315826196
Futterman Collier, A., & Wayment, H. A. (2021). Enhancing and explaining art-making for mood-repair: The benefits of positive growth-oriented instructions and quiet ego contemplation. Psychology of Aesthetics, Creativity, and the Arts, 15(2), 363– 376. https://doi.org/10.1037/aca0000286
Gibson, D (2018). A visual conversation with trauma: visual journaling in art therapy to combat vicarious trauma. Journal of the American Art Therapy Association, 35(2), 99-103. DOI:10.1080/07421656.2018.1483166
Grant, C. & Osanloo, A. (2014). Understanding, selecting, and integrating a theoretical framework in dissertation research: creating the blueprint for your "House". Administrative Issues Journal Connecting Education 4(2), 12-26. DOI:10.5929/2014.4.2.9
Guzman, A., Shim, H., Sia, C., Siazon, W., Sibal, M., Siglos, J., Simeon, F. (2011). Ego integrity of older people with physical disability and therapeutic recreation. Educational Gerontology, 37, 265-291. DOI: 10.1080/03601270903534945
Guzman, A. (2007). Sense of belongingness among Filipino elderdly: the use of doodles in geriatrics research. Educational Gerontology, 33, 1069-1085. DOI: 10.1080/03601270701700664
Heynen, E., Roest, J., Willemars, G., & Hooren, S. (2017). Therapeutic alliance is a factor of change in arts therapies and psychomotor therapy with adults who have mental health problems. The Arts in Psychotherapy, 55, 111-115. 53
Hinz, L. D. (2019). Expressive Therapies Continuum: A framework for using art in therapy (2nd ed.). Routledge. Hongo, A., Katz, A., & Valenti, K. (2015). Art: trauma to therapy for aging female prisoners. Traumatology, 21(3), 201-207.
Howie, P., Prasad, S., & Kristel, J. (2013). Using art therapy with diverse populations: Crossing cultures and abilities. Kingsley Publishers
Huet, V. (2015). Literature review of art therapy-based interventions for work-related stress. International Journal of Art Therapy, 20(2), 66-76, DOI: 10.1080/17454832.2015.1023323
Jordan, V. (2009). Ethical issues with older adults. The California Psychologist, 33-34.
Kapitan, L. (2011). An introduction to art therapy research. Routledge.
Kitchener, K.S. (2000). Foundations of ethical practice, research, and teaching psychology. Lawrence Erlbaum Association, Inc. Knickman, J. R., & Snell, E. K. (2002). The 2030 problem: caring for aging baby boomers. Health services research, 37(4), 849–884. https://doi.org/10.1034/j.1600-0560.2002.56.x
Lim Im, M., Lee, J. (2014). Effects of art and music therapy on depression and cognitive function of the elderly. Technology and Health Care, 22, 453-458.
Linesch, D., Ojeda, A., Fuster, M., Moreno, S., & Solis, G. (2014). Art therapy and experiences of acculturation and immigration. Journal of the American Art Therapy Association, 31(3), 126-132. DOI: 10.1080/07421656.2014.935586
. Logsdon, R. G., McCurry, S. M., & Teri, L. (2007). Evidence-Based Interventions to Improve Quality of Life for Individuals with Dementia. Alzheimer's care today, 8(4), 309–318
Mahendran, R., Ganhi, M., Moorakonda, R., Wong, J., Kanchi, M., Fam, J., Rawtaer, I., Feng, L., & Kua, E. (2018). Art therapy is associated with sustained improvement in cognitive function in the elderly with mild neurocognitive disorder: Findings from a pilot randomized controlled trial for art therapy and music reminiscence activity versus usual care. Trials 19, 615. DOI: https://doi.org/10.1186/s13063-018-2988-6
Majeski, R., & Stover, M. (2019). The expressive arts and resilience in aging. Educational Gerontology, 45, 162-166. DOI: https://doi.org/10.1080/03601277.2019.1580896 54
Malchiodi, C. A. (2012). Handbook of art therapy (2nd ed.). Guilford Press.
Malchiodi, C. A. (2005). Expressive therapies. New York: Guilford Press. Masutani,T., Yamamoto, Y., Konishi, J., & Maeda, K. (2010). Effects of music and art education in early life and oral functions on the QOL of the Takarazuka revue company O.G. compared with general elderly females. Psychogeriatrics, 10, 4-14. Moosa, A., Koorankot, J., & Nigesh, K. (2017). Solution focused art therapy among refugee children. Indian Journal of Health and Well-being, 8(8),811-816
McGuire, J. (2009). Ethical Considerations when working with older adults in psychology. Ethics and Behaviour, 19(2), 112-128. DOI: 10.1080/105008420902772702 McLeod, S. A. (2007). The Milgram experiment. Retrieved from www.simplypsychology.org/milgram.html
McNamee, C. (2004). Using Both Sides of the Brain: experiences that integrate art and talk therapy through scribble drawings. Journal of the American Art Therapy Association, 21 (3), 136-142.
McNiff (2008). Art-based research. In J.G. Knowles & A.L. Cole (Eds.), Handbook of the arts in qualitative research: Perspectives, methodologies, examples, and issues (p. 29-40),
Sage. Miller, R. (2007). The role of response art in the case of an adolescent survivor of developmental trauma. Journal of the American Art Therapy Association, 24(4), 184-190. DOI: 10.1080/07421656.2007.10129470
Moon, B. (2009). Existential art therapy: The canvas mirror (3rd ed.). Charles C. Thomas Books. Moon, B. (2000). Ethical issues in art therapy. Springfield, IL: Charles C. Thomas Publisher.
Munhall, P., & Chenail, R. (2008). Qualitative research proposals and reports: A guide (3rd ed.). Jones and Bartlett. Nguyen, M. (2015). Art therapy: a review of methodology. Dubna Psychological Journal, 29-43
O'Rourke HM, Collins L, Sidani S (2018). Interventions to address social connectedness and loneliness for older adults: a scoping review. BMC Geriatr, 18(1), 214. Doi:10.1186/s12877-018-0897-x
Percoskie, S. (2010). Art therapy with the Alzheimer's client. The Humanistic Psychologist, 25 (2), 208-211. 55
Pike, A. (2014). Improving memory through creativity. A professional's guide to culturally sensitive cognitive training with older adults. Jessica Knightsley Publishers.
Pope, K. & Vasquez, M. (2016). Ethics in psychotherapy and Counselling. A practical guide (5th ed.).
John Wiley & Sons, Inc. Prince M, Bryce R, Albanese E, et al (2013). The global prevalence of dementia: a systematic review and metanalysis. Alzheimer’s and Dementia 9, 63-75.
Rawtaer, I., Mahendran, R., Yu, J., Fam, Johnson, Feng, L., & Kua, E. (2015). Psychosocial interventions with art, music, Tait Chi and mindfulness for subsyndromal depression and anxiety in older adults: A naturalistic study in Singapore. Asia-Pacific Psychiatry, 7, 240- 250.
Riggs, J. (2001). The health and long-term care policy challenges of Alzheimer's disease. Aging & mental health, 5(1), 138-145.
Rosenberg, F. (2009). The MoMA Alzheimer's project: programming and resources for making art accessible to people with Alzheimer's disease and their caregivers. Art & Health: An International Journal of Research, Policy and Practice, 93-97.
Roswiyani, R., Kwakkenbos, L., Spijker, J., & Witteman, C. (2017). The effectiveness of combining visual art activities and physical exercise for older adults on well-being or quality of life and mood: a scoping review. Journal of Applied Gerontology, 1-22. DOI:10.1177/0733464817743332
Rusted, J., Sheppard, L., & Diane Waller. (2006). A multi-centre randomized control group trial on the use of art therapy for older people with dementia. The Group-Analytic Society, 39(4), 517-536. DOI: 10.1177/0533316406071447
Safar, L., & Press, D. (2014). Art and the brain: effects of dementia on art production in art therapy. Journal American Art Therapy Association, 28(3), 96-103.
Schaie, K. W. (2013). Developmental influences on adult intelligence: The Seattle Longitudinal Study (2nd ed.). Oxford University Press. Schore, A. (2014). The right brain is dominant in psychotherapy. Psychotherapy, 51 (3), 388- 397. https://doi.org/10.1037/a0037083
Schwiebert, V., Myers, J., & Dice, C. (2000). Ethical guidelines for counselors working with older adults. Journal of Counseling and Development, 78(2), 123-129. 56
Segal, R. (2008). Chapter 7: helping older mentally retarded persons expand their socialization skills through the use of expressive therapies. Activities, Adaptation &: Aging, 15 (1- 2), 99, DOI: 10.1300/J016v15n01_08
Seifert, L. (2000). Customized art activities for individuals with Alzheimer-type dementia. Activities, Adaptation & Aging, 24(4), 65-74.
Seifert, L. (1999). Procedural skills for art production among individuals with Alzheimer's type dementia. Clinical Gerontologist, 20(1), 3-14.
Sneed, J. R., Whitbourne, S. K., & Culang, M. E. (2006). Trust, identity, and ego integrity: Modeling Erikson's core stages over 34 years. Journal of Adult Development, 13(3-4), 148–157. https://doi.org/10.1007/s10804-007-9026-3
Snow, S., & D'Amico, M. (2009). Assessment in the creative arts therapies: designing and adapting assessment tools for adults with developmental disabilities. Charles C. Thomas Publisher.
Stephenson, R. (2006). Promoting self-expression through art therapy. Generations, 24-26.
Stephenson, R. (2013). Promoting well-being and gerotranscendence in an art therapy program for older adults. Journal of the American Art Therapy Association, 30 (4), 151-158.
Sullivan, G. (2010). Art practice as research: Inquiry in the visual arts (2nd ed.).
Sage. Toshimitsu, M., Shin, K., Ken-Ichi, K., Kiyoko, Ni., & Zazuo, S. (2000). Emotion spectrum analysis method (ESAM) for monitoring the effects of art therapy applied on demented patients. CyberPsychology & Behaviour, 3(3), 441-446.
Wagner, E., & Wiffen, P. (2011). Ethical issues in preparing and publishing systematic reviews. Journal of Evidence-Based Medicine, 130-134. DOI: 10.1111/j.1756-5391.2011.01122.
Walter, A. (2016). An Integrated Theoretical Approach for Applying Evidence-Based Practices to Art Therapy. Senior Capstone Theses. Paper 26. Wang, Q-Y, & Li, D-M. (2016). Advances in art therapy for patients with dementia. Chinese nursing research, 3 (3), 105-108. https://doi.org/10.1016/j.cnre.2016.06.011
Windle, G., Newman, A., Burholt, V., Woods, B., O'Brian, Baber, M, Hounsome, B., Parkinson, C., & Tischler, V. (2016). Dementia and imagination a mixed-methods protocol for arts and science research. BMJ Open, 1-10. 57
Wood, W. (1995). Weaving the warp and weft of occupational therapy: an art and science for all times. American Journal of Occupational Therapy, 49, 44-52. DOI: https://doi.org/10.5014/ajot.49.1.44
Yong, R., Hulbert, S., Camic, P., & Tischeler, V. The impact of viewing and making art on verbal fluency and Memory in people with dementia in an art gallery setting. Psychology of Aesthetics, Creativity, and the Arts, 9(4), 368-375.