The life satisfaction of older adults is reported to be directly affected from the physical and psychological health of the individual, the social relationships, and the environment. Sociodemographic characteristics of the individual1,2 as well as the problems encountered with increasing frequency with old age such as stroke, osteoporosis, physical limitation, urinary incontinence, pain, and depression3 are reported to be among the factors affecting life satisfaction negatively in previous studies.
There are many studies on life satisfaction and it is known to be affected by multiple factors. However, we did not come across any study on the effect of art therapy, which is a complementary and holistic approach, on the degree of this satisfaction. Art therapy is known to provide benefits for individuals with physical disorders. Unlike other therapy types, the creative activities during the sessions take the patient away from the problem and make him or her forget the disorder or the loss of function for a while. Art therapy also allows individuals to live life normally with full physical ability during the time they are creating even if for a short time.4 Types of art therapy include theater, dance, music, cinema,5 painting, glass painting, making jewelry with beads, watercolor painting, clay molding, wood painting, mask making, collage creation, and drawing or painting by looking at a picture.6 Studies where only 1 art therapy method such as drama therapy,7 music therapy,8 or clay therapy,9 or multiple activities such as shaping clay, drawing, and painting with acrylic and crayons and markers have been used are present in the literature.10–12
Art therapy is reported to decrease grief, mourning, negative emotions, and depression while promoting positive memories, recollections,12 socializing,13 language function,8 and quality of life13 in the older adults. Kim11 has found art therapy to decrease anxiety and increase self-respect in the older adults. It has also been reported to have positive effects on the emotional status and cognitive status in patients with dementia in a study by Rusted et al.10 Art therapy was found to decrease depression and have a positive effect on self-expression in older adult subjects with neurocognitive disease.12 A positive effect on the hopelessness level has also been reported in subjects with a neurological disorder.9
The aim in this study was to identify the effect of art therapy on life satisfaction and cognitive function by having the older adults residing in a nursing home involved in a ceramic painting activity, which is a type of art therapy.
MATERIALS AND METHODS
Study design and sample selection
This randomized controlled study was conducted at a nursing home in Turkey between May 18, 2015 and October 30, 2015. The study population consisted of older adults residing at a nursing home in Turkey. The sample was determined by performing strength analysis. According to the result of the strength analysis, a minimum of 14 individuals would be needed to be included in the study at the 89% strength and 5% type 1 error level. A total of 205 individuals were found to reside in the nursing home during the period of the study. The study finally included a total of 30 individuals 65 years of age and older consisting of 15 older adult subjects in the intervention group and 15 in the control group as 95 subjects did not continuously reside at the nursing home (they were newly registered for preliminary investigation to be transferred to other institutions), 55 had Alzheimer-type dementia, 18 were bed bound, 2 had complete visual loss, and 5 rejected participation. Inclusion criteria were residing in the nursing home during the study period, lack of dementia, visual problem or agitation diagnosed by a physician, not being bed bound, and accepting to participate in the study voluntarily.
The data were collected by using a Descriptive Information Form, Mini-Mental State Examination (MMSE), and Life Satisfaction Scale (LSS). The study data were collected by the investigators in the nursing home lounge and the process took 30 to 45 minutes.
The Descriptive Information Form
The Descriptive Information Form was developed by the investigators and consisted of 18 close-ended and 5 open-ended questions. This form included questions on the individuals' demographic characteristics (age, gender, marital status, educational status, profession), medical characteristics (chronic disorders and number of current drugs), daily living activities (status of receiving help for daily living activities and activities performed with help), and characteristics of residing at the institution (duration, reason for preferring this institution, the current room, activities performed at the institution).
Mini-Mental State Examination
The MMSE was first published by Folstein et al.14 The reliability and validity study for Turkey was conducted by Güngen et al.15 Scores range from 0 to 30. Güngen et al15 reported that the threshold value was 23 to 24 and this value had a sensitivity of 0.91 and specificity of 0.95, with high reliability between practitioners (Pearson coefficient: 0.99, κ: 0.92). The MMSE appropriate for the educational status of the subjects in the study was administered by the investigator to both the intervention and control group subjects both in the preliminary and final tests of our study.
Life Satisfaction Scale
The LSS, a validity and reliability study of the scale, was developed by Neugarten et al.16 The scale consists of 20 questions and is short and easy to use. The questions are answered with yes or no and certain questions (3, 5, 7, 10, 14, 17, 18, 20) are reverse coded. A high score indicates that the individual's life satisfaction is high. The cutoff points of the scale are as follows: 0 to 7 points low life satisfaction, 8 to 13 points moderate life satisfaction, and 14 to 20 points high life satisfaction. The LSS was administered by the investigator to both groups in both the preliminary and final tests.16
The names of the nursing home residents who were 65 years of age and older, did not have a diagnosis of dementia, and were not bed bound were received from the health care staff of the institution in the study. The investigators administered MMSE and LSS in accordance with the subject's educational status after interviewing the subjects individually with the face-to-face technique after informing them about the study. The individuals were then ordered in the list according to the time of study inclusion and those with odd numbers made up the intervention group while those with even numbers made up the control group. An administration calendar was developed together with the individuals who constituted the intervention group. The ceramic painting sessions took place in groups of 5, twice a week for 8 weeks with each session taking 30 to 35 minutes, one accompanied by a fine arts specialist and the other by the investigators each week. The investigators received 4 hours of practical training regarding ceramic painting from fine arts expert before the sessions started. Patterns in a size that the older adults could paint easily were drawn on the ceramic plates and tiles by the investigators before the beginning of the administration. The sessions took place on Tuesdays and Thursdays with the women and on Wednesdays and Fridays with the men. The first 5 to 10 minutes of each session were spent chatting with the older adults and the individual was then given time to choose the type (tiles, vases, figurines, and plates) and color of the ceramic. The painting activity that lasted 30 to 35 minutes then took place. Feedback was provided by the investigators on the ceramic material painted by the individuals in the last 10 minutes of each session and the individuals were asked to give feedback regarding the ceramics of the other group members. The name of each individual was written under the ceramic material painted by him or her at the end of the painting sessions. The subjects painted a ceramic object at each session. The individuals were informed by the investigators that the ceramic materials painted by each individual would be given to them at the end of the practice. Makeup sessions were provided after the sessions were finished for the subjects who could not complete 8 weeks. The ceramics painted by the subjects were glazed and baked by the investigators after the sessions of all individuals were completed. The ready-to-use ceramics were then given to the older adult individuals as a gift. The MMSE and the LSS were administered again to the subjects by the investigators after the practical part ended.
The individuals in the control group did not undergo any procedure, and MMSE and LSS were administered only at the beginning and end (8 weeks later) of the study.
The SPSS 16.00 software program was used for data analysis. The descrıptive data used in the analysis included numbers and percentages, and mean and standard deviation. The Mann-Whitney U test and χ2 test were used to compare the descriptive features and nursing home–related data of the intervention and control group subjects. The time-related and intergroup differences of scale scores were investigated with variance analysis in repeated measurements and pairwise comparisons were conducted with the Bonferroni test. The significance level was accepted as P < .05.
We obtained ethical permission from the Aksaray University Human Studies Ethics Committee (2015/4) and official permission from the Ministry of Family and Social Policies. The study was explained to the study participants and written consent was obtained.
Limitations of the study
The most important limitation of the study is the use of the small sample size. The results obtained in this study are limited to the older adults residing at a nursing home in Turkey.
The mean age of our subjects was 74.5 ± 9 years. In the intervention group, 53.3% were younger than 74 years, 73.3% were female, 73.3% were illiterate, and 53.3% were married. All of the individuals in the intervention group suffered from at least 1 chronic disorder and received help while performing at least one of the daily living activities in our study.
In the control group, 53.3% were older than 75 years, 66.7% were female, 53.3% were illiterate, and 66.7% were single. We found that 60% of the control group subjects had at least 1 chronic disorder and received help while performing at least one of the daily living activities in our study. No statistically significant difference was found between the descriptive characteristics of the individuals in the intervention and control groups (P > .05) (Table 1).
The mean MMSE score of the intervention group increased statistically significantly after art therapy (P < .05). The mean LSS score of the intervention group also increased compared with the mean LSS score of the control group at the end of art therapy, but this increase was not statistically significant (P > .05) (Table 2).
A statistically significant increase was found in the mean MMSE scores of the intervention group compared with the control group following art therapy in our study (P < .05) (Table 2). Kim et al12 found art therapy to have a positive ++effect on self-expression in their study on elderly people with neurocognitive disorders. Art and creativity have been reported to be important aspects of being physically, emotionally, and mentally healthy.17,18 Reading books or newspapers, painting, physical and cognitive exercise, and art therapy have been reported to have a positive effect on cognitive function due to the mental stimulation they provide in various studies.19–21 The results of our study are similar to those of others in the literature where the effect of art-related activity on cognitive function was investigated. However, Laura et al22 found no change in the cognitive status of their patients with dementia in a study they conducted by implementing a relaxing rhythm program.
We found an increase in the mean LSS scores of the intervention group at the end of art therapy but the difference was not statistically significant (P > .05) (Table 2). The level of life satisfaction is related to mental well-being and healthy aging.23 As reported in the literature, increased social interaction between the elderly has a positive effect on the well-being level and life satisfaction.24 Arpacı25 investigated the quality of life in older adults staying at a nursing home and found that spending time with handicraft may be important for the elderly to make the best use of their time and continue to produce. Kim11 found art therapy to decrease anxiety, increase self-respect, and thus have a positive effect on healthy living in a study on the effect of art therapy in the older adults. Kim et al12 emphasized art therapy to promote self-expression skills and decrease the anxiety level in a study on elderly subjects with a neurocognitive disorder. Blomdahl et al26 found art therapy to have a positive effect on self-expression, understanding, explanation, creativity, and emotional status. Brotons and Marti27 found that depression affecting the quality of life negatively was decreased with the music therapy they used in patients with Alzheimer disease. Similar results were also found in studies conducted with different patient groups. For example, art therapy was found to decrease anxiety, depression and fatigue sensation, and stress symptoms, and increase the quality of life in studies on patients with cancer.28–30 The result of the study showed similarity with the literature and indicated that regular participation of the subjects in art therapy sessions allowed them to get to know each other. A positive change is also thought to occur in life satisfaction with the socialization of the individuals as a result of the communication and interaction with each other by participating in therapy sessions.
Art therapy (ceramic painting activity) in older adults staying at a nursing home was found to have a positive effect on the cognitive status and life satisfaction in our study. Art therapy should be added to in-service training programs of all health care staff serving in nursing homes to promote its wider use in these settings. A proper environment and conditions should also be provided for the older adults for art therapy procedures such as clay shaping, drawing, and painting with acrylic and crayons or markers by taking their personal preferences and skills into account. We recommend performing similar studies with larger patient groups and using different kinds of art activities.
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