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National Academy of Sciences The National Academies Workshop on Research Gaps and Opportunities for Exploring the Relationship of the Arts to Health and Well-Being in Older Adults September 14, 2012 The National Academy 500 Fifth Street, NW Room 100 Washington, DC 20001 Proceedings by: CASET Associates, Ltd. Fairfax, Virginia 22030 (703) 266-8402 NOTE: This is an edited verbatim transcript of the workshop Research Gaps and Opportunities for Exploring the Relationship of the Arts to Health and Well-Being in Older Adults held on September 14, 2012, prepared by CASET Associates and is not an official report of National Academy of Sciences, the National Academy of Engineering, the Institute of Medicine, or the National Research Council (the “National Academies”) Opinions and statements included in the transcript are solely those of the individual persons or participants at the workshop, and are not necessarily adopted or endorsed or verified as accurate by the National Academies. CONTENTS Introduction and Welcome 1 Chair: David Reuben, UCLA Welcome on Behalf of the National Academies 4 Connie Citro, Committee on National Statistics Intended Workshop Outcomes 8 Marie Bernard, National Institute on Aging, National Institutes of Health; Rocco Landesman and Sunil Iyengar, National Endowment for the Arts The Relationship of Arts Programs and Interventions to Psychological Well-Being, Cognitive, Sensory, and Motor Skills Function in Older Adults, and the Underlying Neural Processes 19 Moderator: Art Kramer, University of Illinois Participatory Arts for Older Adults: Benefits and Challenges 21 Tony Noice, Elmhurst College; Helga Noice, Elmhurst College; and Art Kramer, University of Illinois at Urbana-Champaign Music and Aging: Exercise for a Well-Tempered Mind 36 Nina Krause, Northwestern University and Alexandra Parbery-Clark, Northwestern University Floor Discussion 54 Comparative Benefits or Weaknesses of Arts Therapies Over Other Behavioral and/or Pharmacological Interventions for Older Adults Experiencing Declines in Cognitive, Sensory, and/or Motor Ability Moderator: Becca Levy, Yale University "Shall I Compare Thee to a Dose of Donepezil?": An Overview Intervention Research in Dementia Care 68 Kate de Medeiros, Miami University and Anne Basting, University of Wisconsin-Milwaukee Music and the Brain in Health and Disease: What we learned from Correlational, Longitudinal, and Stroke Recovery Studies 84 Gottfried Schlaug, Harvard University 3 Using Music to Manage Symptoms of Dementia: What is the State of the Science? 100 Julene Johnson, University of California San Francisco Floor Discussion 115 Cost-Benefit Analyses Associated with the Inclusion of Arts Programs and Interventions in Healthcare Delivery for Older Adults 128 Moderator: David Reuben, UCLA A Primer on Cost Benefit Analysis 128 Emmett Keeler, RAND and UCLA Cost and Cost Effectiveness in the Translation from Randomized Controlled Trials to Community Evidence- Based Arts Programs 146 Thomas Prohaska, George Mason University and Melissa Castora-Binkley, University of South Florida Discussant: William Spector, Agency for Healthcare Research and Quality 164 The Relationship of Aesthetics and Design Factors to Health and Quality-of-Life-Related Outcomes of Older Adults in Long-Term Care and Assisted Living Facilities 178 Moderator: Sandra Crewe, Howard University How the Design of the Assisted Living and LTC Environment Impacts the Success of Arts Programs 181 Victor Regnier, University of Southern California, Los Angeles The Role of Visual Art in Improving Quality-of-Life Related Outcomes for Older Adults 202 Kathy Hathorn, American Art Resources Discussant: Valerie Fletcher, Institute for Human Centered Design 216 Floor Discussion 224 4 Research Gaps and Opportunities: A Summary 229 Moderator: David Reuben, UCLA Margie Lachman, Brandeis University Art Kramer, University of Illinois at Urbana- Champaign Becca Levy, Yale University Floor Discussion 254 1 P R O C E E D I N G S Agenda Item: Introductions and Welcome DR. REUBEN: Good morning. I am Dave Reuben. I am a geriatrician based at UCLA and I am delighted to be here. I am just thinking if I were not here, I would just be sleeping. Thank you. I think we have a very stimulating day. I am going to keep my remarks very brief right now. But I would like to say that I am a geriatrician. A good bit of my life is spent taking care of old people. My youngest is in her late 60s and my oldest is almost 101. Most of my patients are in their 80s or older. I would just like to tell you about four of my patients very briefly. This should not take more than an hour or two. The first is an 86-year-old man who is an architect and is kind of internationally renowned who is jet setting around the world and I cannot keep up with the guy because he is all over the place and still incredibly productive and thinking about the next big job. The second is an 87-year-old patient of mine who was a television director and directed a lot of the sitcoms that I grew up with in the '50s and '60s. He is now writing plays and going to the Actors Workshop and places like that to get them to read and such like that. Actors’ Gym is what he calls it. 2 The third is a woman who is 92 years old and she is about yea big. She has shrunk considerably. She is very interesting. She is an artist who has been active all of her life and she works in big sculptures. That is her big thing. Big sculptures. And she does these little mock ups and they have these fabricators that make them life size and bigger. And she is still working. Despite a number of hospitalizations recently, she is still working. And the fourth is a 94-year-old man. I just went to his birthday party. He was a musician all of his life. He went to Curtis Institute in Philadelphia. And a classmate of his a couple of years ahead of him was Leonard Bernstein. And he still remembers when Leopold Stokowski asked him to come to New York and he said he did not want to leave Los Angeles. This guy is a very interesting fellow. He is a violinist. He became concertmaster for the Hollywood Bowl and played on just about every record that you grew up with. He worked with everybody from Frank Sinatra to Donna Summer. About a year and a half ago, he asked me if I would write some words for some music that he was writing. Here he is. He is 94 years old and he is still very active. What is it about these four patients of mine? Are these just exceptional people? I would say as a geriatrician that all of my patients are exceptional. But 3 in fact, these are folks who are in very late years and are still quite active. The thing that they have in common is they are artists, they are really committed to their art, and they are very engaged at this point. These are anecdotes. This is not science. And the question before us today is is there a science behind this or are we dealing with just exceptional people who defy the odds? Today we are going to really begin to look at what the evidence base is and what is missing. What more do we need to know? Is art the fountain of youth? We were talking about this yesterday and reading over the papers. The one thing that is great about art and engagement in arts is there are virtually no side effects. It is really great. It is not like some of these medicines we give people. What is the potential for this and how can we exploit the potential to its benefit? We have a wonderful group of people who are going to be speaking today. And hopefully we will be raising more questions than answering them. But the idea is how to go forward towards answering them so that when I am in my 80s and 90s, I know what is best to keep me young. I am going to turn over the comments to Connie Citro who is here representing the Committee on National Statistics, the host of this conference. She will say a 4 few words about the National Academies' involvement. Agenda Item: Welcome on Behalf of the National Academies DR. CITRO: Thank you. I am delighted to be here to welcome you all at the National Academies' Keck Center to this workshop with this long, but very important title of Research Gaps and Opportunities for Exploring the Relationship of the Arts to Health and Well-Being in Older Adults. You are going to be hearing from the National Institutes of Health and the National Endowment for the Arts. Several institutes and centers and offices in NIH came together with NEA to talk to the academy about putting on this event. The Committee on National Statistics, which I direct, is a standing unit at the National Academy of Sciences. It was set up in 1972 when a presidential commission on federal statistics said we have the most decentralized statistical and also research operation in the world and this has many benefits. There are lots of innovations and innovative ideas that come from it. But it can make it sometimes difficult to coordinate efforts. Our committee was set up to be a body that could endeavor to help the statistical and research communities use state-of- the-art art methods and coordinate some of their 5 activities, and we try to do that to the best of our ability. There are about 60 different units like this in the academy. They have names like the Food and Nutrition Board and the Army Research Science Board and Committee on Population.
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