Arts-based intervention to help depressed seniors living in the community

Hong Kong is a developed society with the longest life expectancy in the world. According to the Census and Statistics Department, there were 2.14 million people aged 60 or over in mid-2022, representing more than a quarter (29.4%) of the total population. Research shows that around one in ten older adults suffer from depression, a major concern for local mental health issues.
Geriatric depression often leads to adverse consequences such as reduced cognitive ability, worse treatment outcomes for medical conditions, and higher mortality in older adults.

With the booming aging population in Hong Kong and the outbreak of the COVID-19 pandemic, the number of elderly people suffering from depressive symptoms in recent years has increased. Studies have shown that older people in Hong Kong have significantly more depressive symptoms than their counterparts in Taiwan and Guangzhou, but local attention and support for people with mild to moderate depression is very limited.

A community-based project to promote geriatric mental health using Expressive Arts-Based Intervention (EABI) was initiated between July 2017 and June 2021 by the Center on Behavioral Health (CBH) at the University of Hong Kong. EABI is one of the non-pharmacological interventions that is growing in popularity around the world. It refers to a multimodal approach, which uses the creative process of different art forms (i.e. visual arts, music, dance, theater and creative writing) to promote growth personal and healing.

Throughout the aging process, the changes in life and well-being can be an indescribable experience. EABI offers seniors a non-verbal way to express their thoughts and feelings. It also encourages them to use their imagination and creativity to break through the limits of aging. By emphasizing aesthetic appreciation, they could also learn to appreciate each other’s beauty and strengths. All of these could contribute to improving the physical, psychosocial and spiritual well-being, as well as the overall quality of life of older people.

To combat the rising cases of geriatric depression and maximize the number of beneficiaries, CBH has held a number of public educational talks to raise awareness about geriatric depression and encouraged the public to reach out to those in need. .

The team also designed an EABI protocol for the elderly, which consisted of eight 90-minute sessions. The content of the protocol was delivered to frontline workers at local senior centers through a “train the trainer” approach to improve their knowledge and skills in using the EABI to support elderly people in need.

The training was delivered by two licensed expressive arts therapists. It was a three-day program with a total of 18 contact hours. The training began with an introduction to the prevalence and concerns of geriatric depression, as well as the principles of EABI, followed by experiential learning of all artistic creation processes designed for older adults according to the EABI protocol. .

Facilitation skills and concerns about conducting EABI with older people were illustrated. After the training, frontline workers could become project ambassadors and were expected to facilitate two EABI groups in the organizations they served to support older people with mild to moderate depressive symptoms. CBH also provided one-on-one follow-up to seniors who needed intensive psychosocial support services upon recommendation from the Ambassadors.

Over the past four years, the project has held six public educational lectures, seven vocational training sessions, 283 EABI groups, 692 individual follow-up sessions and four art exhibitions, benefiting more than 2,207 seniors, 260 professionals and 37,561 community members.

The CBH research team conducted an evaluation study on 1) the effectiveness of EABI in relieving depressive symptoms in older adults, as well as improving their quality of life, perceived social support and well-being. to be spiritual; and 2) the effectiveness of training in improving the level of altruism of ambassadors in applying the EABI in their workplace.

Participating seniors were asked to complete a questionnaire before and after the EABI, while ambassadors were asked to complete a questionnaire before and after the training, as well as at the end of the EABI. Some of the seniors and ambassadors were also invited to participate in a focus group interview at the end of the program to share their experiences with the research team.

The team successfully recruited a total of 1,089 seniors and 260 ambassadors to participate in the study. The conclusions are as follows:

1. The quantitative results showed:

(i) There were significant improvements in depressive symptoms, overall quality of life, and spiritual well-being in older adults after participating in the EABI. There was also a significant increase in the mean amount and social support satisfaction score.

(ii) The altruistic attitude and self-efficacy of the ambassadors to apply the EABI in their work environment increased significantly after the training.

2. The focus group interviews revealed:

(i) The physical, psychosocial and spiritual well-being of the elderly has been improved. EABI’s music and dance activities gave them the opportunity to exercise their bodies, which helped to strengthen the connection between their body and their brain. The process of creating art was fun and relaxing, so seniors could develop a sense of accomplishment and more easily express their stories and feelings. This helped ease their unpleasant feelings. The group also offered them the chance to experience the joy of participating in community activities, which strengthened their bond with others and increased their motivation to participate in other activities in the future.

(ii) The training program enhanced the knowledge of the Ambassadors on the EABI, enriched their existing skills and improved their ability to empathize with older people.

Overall, the results of this study confirmed the effectiveness of EABI in relieving depressive symptoms in older adults and improving their quality of life, perceived social support, and spiritual well-being. Professor Rainbow Ho, director of CBH, hopes that this project will become a seed for the EABI to be more widely accepted and applied to the holistic care of the elderly.

Provided by the University of Hong Kong

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Arts-based intervention to help depressed seniors living in the community

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