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University of Tennessee, Knoxville
Trace: Tennessee Research and Creative
Exchange
Nursing Publications and Other Works Nursing
1-1-2007
Creativity in Older Adults: A Plethora of
Possibilities
Kenneth D. Phillips
University of Tennessee - Knoxville, kphill22@utk.edu
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Recommended Citation
Flood, M., & Phillips, K. D. (2007). Creativity in older adults: A plethora of possibilities. Issues in Mental Health Nursing, 28, 389-411.
Issues in Mental Health Nursing, 28:389–411, 2007
Copyright
c
Informa Healthcare
ISSN: 0161-2840 print / 1096-4673 online
DOI: 10.1080/01612840701252956
CREATIVITY IN OLDER ADULTS: A
PLETHORA OF POSSIBILITIES
Meredith Flood, PhD, APRN, BC
University of North Carolina at Charlotte, Department
of Family and Community Health Nursing, Charlotte,
North Carolina, USA
Kenneth D. Phillips, PhD, RN
University of Tennessee, College of Nursing, Knoxville,
Tennessee, USA
Aging continues to be an important topic of study. For many
older adults, the elder years can be a challenging, if not
difficult, time. Creativity interventions have been shown to
positively affect mental and physiological health indicators.
The process of creating and one’s attitude toward life may
be more important than the actual product or tangible
outcome. While many activities are those typically thought
of as creative, such as painting, there are also a number of
useful interventions that are not traditionally identified as
creative ones, but that are, in fact, creative activities. This
paper describes recent work with creativity in older
adults, including research and clinical projects, and earlier
works that could be refined as creative interventions.
Recommendations for further investigation of creativity also
are presented.
Aging is an increasingly popular and important topic for research.
Currently there are 54 longitudinal studies underway through the Na-
tional Institute of Aging (National Institute of Aging, 2005). In 2000,
there were 35.0 million people, or about one in every eight people, 65
years of age or older in the U.S. (Administration on Aging, 2001). In
Address correspondence to Meredith Flood, University of North Carolina at Charlotte, De-
partment of Family and Community Health Nursing, Colvard 2054B, 9201 University City Blvd.,
Charlotte NC 28223-0001. E-mail: mflood@uncc.edu
389
390 M. Flood and K. D. Phillips
2001, life expectancy at birth reached a record high of 77.2 years, in con-
trast to a 47.3 year life expectancy projected in 1900 for someone born
that year (Centers for Disease Control and Prevention [CDC], 2003).
Heart disease, hypertension, arthritis, and cancer are among the most
common and costly chronic conditions affecting older adults (Federal
Interagency Forum on Aging, 2005), and at least 80% of those per-
sons over age 65 have at least one chronic health condition (Varcarolis,
2002). In light of statistics such as these, it is understandable that ag-
ing is a challenge for many older adults. The purpose of this paper is to
present and discuss research findings that support the role of creativity, a
useful characteristic for aging successfully. Synthesis of these findings
demonstrates that creative endeavors are desired by older adults, and
have comprehensive positive health benefits.
ADAPTATION TO CHALLENGES OF AGING
Problems such as increasing numbers and severity of health problems,
declining functional abilities, financial constraints, and loss of social sta-
tus are a few of the potentially life-changing issues that older adults may
face. According to Tabloski, “Psychological changes and chronic illness
associated with older adulthood may affect a person’s functional abili-
ties; however, the psychosocial changes associated with older adulthood
are often the most challenging and demanding” (Tabloski, 2006, p. 190).
Many psychosocial challenges are due to changes in roles, relation-
ships, losses, and living environments (Tabloski). Certain age-related
changes are inevitable; deaths of friends, retirement, decreased auto-
nomic nervous system performance, and reduced cardiac contractility
are examples (Berk, 2004). Developing creative coping strategies can
enable older adults to adapt more effectively to physical, psychological,
and psychosocial changes that occur during old age.
This emphasis on adaptability or coping is central in many theories
of well-being and health in later life (Rowe & Khan, 1998; Stowell,
Kiecolt-Glaser, & Glaser, 2001). Roy and Andrews (1999) reference
Erikson’s (1985) developmental theory in their work. In the Roy Adapta-
tion Model, Roy defines adaptation as the process and outcome whereby
individuals use conscious awareness and choice to create human and en-
vironmental integration. Through their decisions, people are responsible
for the assimilation of creative processes (Roy & Andrews). Thus, adap-
tation involves some degree of creativity.
Many older adults might not describe themselves as creative and
would be reluctant to engage in typical creative endeavors, such as
painting or drawing. Indeed, Kerka (1999) notes that older adults seem
Creativity in Older Adults 391
to experience a decrease in the ability to generate a quantity of novel
ideas, but that later life may afford more time for reflection and creative
pursuits aimed at construction of one’s life story. Addams-Price (1998)
concludes that late-life creativity reflects aspects of late-life thinking:
synthesis, reflection, and wisdom. Therefore, in determining the pres-
ence of creativity from a developmental perspective, one should con-
sider whether the characteristics of reflection, restructuring, synthesis,
and wisdom are present.
Defining Creativity
Although there is some variation, definitions of creativity tend to
share central characteristics, including problem-solving ability and cre-
ating novel products or outcomes. Creativity is a process requiring an
individual to be open to new ideas and approaches, in order to seek an
original solution for a problem or challenge at hand (Fisher & Specht,
1999). Creativity also has been described as the range of cognitive and
emotional processes involved in the conception of meaningful products
(Addams-Price, 1998); as a meta-cognitive process that generates novel
and useful associations, attributes, elements, images, or sets of opera-
tions, and better solves a problem, produces a plan, or results in a product
clearly not present before (Pesut, 1990); or as the ability to recognize a
problem and experiment with new ideas to solve the problem using diver-
gent and convergent thinking (Fasnacht, 2003). Ultimately, the creative
process challenges one to use accumulated skills to manipulate tools
and resources to express a vision or idea. From a problem-solving per-
spective, creativity is an asset in older adulthood, given the number of
health, functional, and financial limitations likely to occur.
Besides a novel product or outcome, other positive changes occur as a
result of creativity. Creativity offers a channel to respond to the limits and
uncertainties of existence (Hickson & Housely, 1997). Through creative
activity, the individual deepens an understanding of self and cultivates
purposeful or meaningful involvements (Fisher & Specht, 1999). Older
adults who engage in creative activities are strengthening a sense of self
that is competent, efficacious, and capable of doing (Fisher & Specht).
Therefore, in terms of novel productions, it is not only the end result,
but the process of getting there that benefits the older adult. Through
learning about oneself and contributing something to the world, it may
be possible to experience personal growth and transcend the immediacy
of problems associated with old age.
Potential benefits of creativity to elder health include mental clarity,
increased awareness, and a means for expressing the elusive, such as
392 M. Flood and K. D. Phillips
the divine or spiritual experiences of life, resolution of longstanding
conflicts, continued adaptation, improved emotional states, and physical
healing (Beck, 2005). Given the benefits of creativity for older adults, it is
understandable that creativity has been the focus of a number of clinical
projects and research studies. Purposeful or productive activity has been
shown to be related to well-being in later life (Fisher 1995; Fisher, Day,
& Collier, 1998). Having some form of social activity, leisure activity, or
hobby has been identified as important for surviving in old age (Glass, de
Leon, Marattoli, & Berkman, 1999; Lennartsson & Silverstein, 2001).
Many projects and studies have involved participants utilizing original
thinking and problem-solving abilities in order to make new products,
or engaging in various forms of leisure or favorite pastimes. However,
while they possess the characteristics of creative activities, many of these
works have not been recognized as creative interventions per se. If one
considers creativity from a developmental perspective, interventions that
stimulate individuals’ reflection, restructuring, and synthesis of ideas and
wisdom also could be characterized as creative activities. Older adults
who have been asked about creativity or aging have suggested similarly.
QUALITATIVE RESEARCH
A qualitative study by Fisher and Specht (1999) examined the mean-
ings older adults attached to successful aging and aging’s relationship
to creativity. The researchers’ content analysis identified six features
of successful aging: a sense of purpose, interaction with others, per-
sonal growth, self-acceptance, autonomy, and health. Participants be-
lieved successful aging encompassed a coping orientation involving a
positive attitude toward life and aging. The researchers concluded that
this coping pattern probably had its roots earlier in life and continued
to be used a strategy for successful living. When asked to define cre-
ativity, participants identified actual production of artwork or practicing
of skills, and thinking about things in new ways. The two categories
of creativity described capture the notion of creativity as both a way of
thinking and a way of doing. Thus, for participants, creativity involved
a connection between thought and imagination, and application of these
ideas through the process of creating something. Fisher and Specht con-
cluded that creative activity contributes to successful aging by encourag-
ing development of problem-solving skills that translate into a practical
creativity in older adults’ daily living. They also found that creativity
fostered a sense of competence, purpose, and growth, also contribut-
ing to successful aging. In describing creativity, Fisher and Specht’s
participants identified problem-solving abilities and creation of artistic
Creativity in Older Adults 393
products. For these older adults, it was the process of creative activity
as well as the outcomes that were important related to successful aging.
Another study (Bickerstaff et al., 2003) examined how older adults
in nursing homes dealt with losses in later life. Participants were asked
open-ended questions about their life in a long-term care facility and
what behaviors helped keep them as healthy as possible. Just over 50% of
the 180 participants spoke of behaviors suggestive of self-transcendence.
The researchers identified five categories of self-transcendence: gener-
ativity, introjectivity, temporal integration, body transcendence, and re-
lationships with self/others/Higher Being. A component of the introjec-
tivity category of self-transcendence was interiority (being involved in
hobbies, travel, and lifelong learning), activities that are indicative of cre-
ativity. Specific activities cited by the participants included crafting, de-
riving pleasure in remembering the past (reminiscence), and presenting
travelogues to fellow residents. Interestingly, the body-transcendence
category in this same study also reflected creative processes; exhibiting
industry in the face of adversity, from the flexibility subcategory, was a
behavior that reflects creativity.
The older adult participants in the study by Bickerstaff and colleagues
(2003) identified creativity in the form of problem-solving and the ability
to think of things in new and different ways, and in instances where
positive outcomes resulted. Just as important as the outcomes reached
was the profound personal growth participants experienced through the
use of their creativity, which allowed transcendence of the difficulty
of loss during late life. The findings of Fisher and Specht (1999) and
Bickerstaff et al. (2003) indicate a cognitive process-oriented notion of
creativity, which is in line with the assertions of Addams-Price (1998),
Beck (2005), and Kerka (1999).
QUANTITATIVE RESEARCH
Activities that are typically identified as creative include dance, music,
poetry, and theater (Ebersole & Hess, 1998). However, other activities in-
volve the features of creativity: openness to new ideas, problem-solving
abilities, creating novel, meaningful products, solutions, or outcomes,
and convergent and divergent thinking. These activities include remi-
niscing and different kinds of group work. Older adults’ participation in
these kinds of activities requires and may also cultivate creative abilities.
Moreover, reminiscing and group work have been linked with positive
mental health. More traditional creative activities, including art therapy,
poetry, and journaling, have been associated with positive outcomes in
older adults as well.
394 M. Flood and K. D. Phillips
Art Therapy
The largest study of creativity to date is Cohen’s (2005) investigation
of the impact of professionally conducted cultural programs on older
adults. This study involved 150 treatment and 150 control participants
aged 65 and older, who were matched in terms of health and functioning
at the start of the study. Control participants were permitted to engage
in their routine activities; however, none of them became involved in
rigorous and sustained participation in art programs during the course
of the study (Cohen). Treatment participants met for 35 weekly meetings
and were also given between-session assignments as well as outings to
exhibitions, concerts, and concerts (Cohen).
Participants were measured in terms of mental health, physical health,
and social functioning at the beginning, midway through, and at the
end of the art programs. A general health systems survey measured
health data and number of medications; the Philadelphia Geriatric Cen-
ter Morale Scale, the UCLA Loneliness Scale, and the Geriatric De-
pression Scale measured mental health; and a detailed inventory about
the nature, frequency, and duration of activities measured social func-
tioning (Cohen, 2006). Start dates for the study were staggered for
the three sites, and the study remains underway at two of them. How-
ever, preliminary data from the Levine School of Music site are com-
plete and look promising. These participants were involved in a chorale
group, which practiced together and performed a number of concerts
over the duration of the study. At this site, many people actually im-
proved their health over the course of the study. These findings are
especially remarkable for a sample whose average age of 80 (range
of ages is 65–100) is greater than the current life expectancy (Cohen,
2005).
Preliminary findings show that the treatment group reported better
health one year after baseline starting point measures; the control group
reported their health was not as good one year post baseline measures
(Cohen, 2006). Furthermore, the intervention group reported an aver-
age of 9.27 doctor visits per year while the control group reported an
average of 13.19 visits per year. Both groups had more visits when com-
pared to baseline, but the control group’s visits increased at a greater rate
(Cohen, 2006). Likewise, the control group reported significantly more
falls during the past 12 months than did the treatment group; the treat-
ment group reported less falls at one year follow up than they did at
baseline, while the control group reported more falls than they did at
baseline (Cohen, 2006). The results also showed a significant difference
in the number of self-reported hip damage between the groups over the
Creativity in Older Adults 395
past 12 months; the control group reported a significantly higher mean
number of incidences of hip damage than did the intervention group
(Cohen, 2006).
Medication use also was influenced; medication use increased at a
greater rate in the control group as compared to the intervention group.
Mean differences revealed that at one-year follow-up, participants in the
control group reported taking more medications than at baseline; the
average number of medications reported by the intervention group at
the one-year follow-up was 6.97, while the average number of medica-
tions reported by the control group at the one year follow-up was 8.48.
Vision problems diminished over time in the intervention group; partici-
pants in the intervention group reported less vision problems at one-year
follow-up than at baseline. Mental health was positively affected by the
intervention as well; an examination of the means revealed that the in-
tervention group revealed significantly lower levels of depression than
did the control group after one year. An examination of the Loneliness
Scale means showed that the intervention group had a mean loneliness
score of 34.47 while the control group reported a mean score of 37.05
(significantly higher than the intervention group; the higher the score,
the more lonely) (Cohen, 2006). The intervention also group had a self-
reported morale score that was significantly higher (higher morale) than
the control group (14.07 and 13.07, respectively) one year after baseline
measures.
After a year, activity levels had changed in both the intervention and
the control groups, but in different directions; the intervention group
increased by an average of two activities per person, while activities
among those in the control group dropped by an average of two activ-
ities per person. Based on the data from Cohen’s Levine School site,
the effects of participation in a music arts program has a wide range
of therapeutic health benefits that affect many aspects of physical and
mental health of older adults. Reasons for these initial outcomes in-
clude gaining a sense of mastery, experiencing social engagement, and
the enjoyable, engaging nature of art experienced by treatment partic-
ipants (Cohen, 2005). Thus far, only positive outcomes have resulted
from this landmark study, and this trend is expected to continue as data
from the remaining sites are analyzed. This study is exciting in that it
is the largest and first longitudinal one that examines creativity in older
adults.
Other favorable results include those of Krawczynski and Olszewski
(2000), who designed a multimodal program aimed at influencing a
group of 75 older adult participants’ purpose in life, depression, and
hypochondriasis, by targeting physical, mental, and spiritual well-being.
396 M. Flood and K. D. Phillips
Interventions included rhythm and dance exercises; general physical ex-
ercises; recreational exercise outdoors; relaxation exercises; a creativity
enhancement seminar; a seminar on psychology and philosophy of life;
and a seminar on contact with other people and communication. The
group sessions were conducted two days per week over a period of four
months. The first day each week consisted of an hour of some form
exercise and a two hour seminar. The second day each week was com-
prised of one hour of relaxation, an hour of exercise, and two hours
of seminar on stimulating creativity. Purpose in life, depression, and
hypochondria were three parameters of well-being that were measured
pre and post-intervention. The Purpose in Life Scale (PIL) measured pur-
pose in life, the Geriatric Depression Scale (GDS) assessed depressive
symptoms, and the Hypochondriasis Scale Institutional Geriatric (HIP)
determined the presence of hypochondria. There were statistically sig-
nificant changes in test scores over time. Mean PIL scores increased from
pre-intervention to post-intervention, suggesting greater purpose in life,
and these scores remained increased at six months post-intervention.
Scores for the GDS and the HIP decreased from pre-intervention to
post-intervention, indicating a decrease in depressive symptoms and
hypochondriasis, and continued to be significantly reduced six months
post-intervention. Outcomes suggested that interventions were success-
ful in improving quality of life as evidenced by increased purpose in life
and decreased depression and hypochondriasis. Moreover, the program
effects in the direction of positive mental health changes appeared to be
stable.
Yet another instance where group artistic endeavors have shown
promising results is a clinical project done by McGarry and Prince
(1998). The clinicians developed a series of eight group sessions that
utilized five types of creative formats that included individual and group
poetry, storytelling, drawing, painting, and music. McGarry and Prince
conducted the project on an inpatient psychiatric unit at a Veterans Ad-
ministration hospital. The focus of the groups was creative expression
in a noncompetitive, supportive environment. Goals for the project were
for participants to express their feelings through the use of creative
activities, to verbalize positive statements about themselves in relation-
ship to creative experiences, and to verbalize positive statements about
themselves in relationship to other patients in the group. To evaluate
progress toward these goals, the clinicians asked participants what color
best described them; to rate how they felt, using an adapted version of
the Smiley Five Face scale; whether they were creative or not creative;
whether they felt safe or not safe; and, whether they felt accepted or
not accepted. Overall, group members gave positive feedback about the
Creativity in Older Adults 397
creative group sessions. Poetry and storytelling were identified as their
favorite activities. In terms of change, there was little or no difference
in measures of facial affect, feeling creative, feeling safe, or feeling
accepted. However, this was not a research study and the methodol-
ogy lacked rigor. The questions the clinicians asked were not validated
measures and they modified the Smiley Five Face Scale from its origi-
nal form. Therefore, it is likely that these issues affected their findings.
Qualitatively speaking, the project had many positive effects on group
members. Seventy-three percent of the participants (n = 81) remained
involved throughout the course of the project and completed the pre-
and post-tests. The clinicians noted ”much laughter and camaraderie”
(McGarry & Prince, 1998, p. 22) during the group poetry session. The
participants liked the poetry activity so much that they decided to write
an additional poem to summarize all of the poems they had written in
group. Participants also gave positive feedback about the storytelling ac-
tivity. One participant commented that there should have been a bigger
smile on the faces scale to denote how good he felt. McGarry and Prince
also cite other incidents that occurred that suggested that participating
in the groups was a meaningful experience for individual participants.
Research studies and clinical projects about the benefits of creativity
groups for older adults suggest that there are multiple therapeutic effects.
Group members may experience enhanced self-esteem, life satisfaction,
improved problem-solving ability, and increased creativity. Moreover, a
sense of universality and belonging can occur as peer relationships are
developed.
Poetry
One popular activity from McGarry and Prince’s project was poetry.
Poetry offers many benefits for the older adult by provoking insight,
promoting life reviews, and encouraging the resolution of unresolved
conflicts (Edwards, 1990). The process of writing poetry can evoke cre-
ative ability in older adults, and the product of writing poetry, a poem, is a
creative art form. Sluder (1990) conducted a poetry writing project in an
outpatient geriatric continuing treatment program. The aim of Sluder’s
project was to get elderly clients to express themselves and to talk about
their feelings. Sluder introduced her clients to poetry by reading them
poems written by elderly people. Initially, she introduced a theme, such a
love, to participants. All statements of what love meant or what thoughts
it evoked were then recorded and used to compose a poem. Sluder then
facilitated a group discussion about the poem. Later in the project, Sluder
expanded the topic of the poems to include the environment or current
398 M. Flood and K. D. Phillips
events, and she implemented the use of props such as flowers. She also
engaged participants in writing group poetry, and later, in writing their
own poems. “Through creating a poem, clients had a positive sense of
accomplishment and, through sharing their poems, they had a feeling
of connectedness with others in the group” (Sluder, 1990, p. 27). Par-
ticipants became more talkative and became more able to identify their
feelings. Poetry writing became an effective therapeutic tool in the pro-
gram; patterns emerged that aided the staff in gaining better insight into
the thoughts and feelings of the elderly clients, which enabled the staff
to develop more effective treatment plans (Sluder, 1990).
Yet another example of the therapeutic use of poetry with the elderly
was the work of Dickson (1999), who involved her ninth grade English
class in a poetry project with nursing home residents. After a training ses-
sion with poet Kenneth Koch, teens were paired with elderly residents.
All the students and their partners worked together on group poems
as well as individual poems composed by the pairs. The project was
well-received by the elderly, who actively participated, and it provided
a good opportunity for the elderly to recall events from their past and
share their memories with a younger generation. Thus, poetry was not
only a vehicle for creative expression, but also stimulated reminiscence
and allowed transmission of values and stories to others.
Journaling
In addition to poetry-writing, other forms of writing have also proven
useful for older adults. Journal writing provides an opportunity for peo-
ple to reflect on and analyze their lives and the events and people sur-
rounding them (Snyder & Lindquist, 2002). Events and experiences are
documented in journals with emphasis placed on the person’s reflections
about these events and the personal meaning assigned to them. Progoff
(1975) contends that journaling enables people to draw on their inherent
resources and to strengthen inner capacities. Baldwin (1990) states that
through journaling, a person possesses the power to deal with life and
assumes responsibility for his or her own growth. Journal writing has
been linked to creativity, expansions of consciousness, and the deepen-
ing of spiritual awareness and growth (Baldwin, 1990; Cameron, 1992;
Rainer, 1997). Through journal writing people are able to connect with
the continuity of their lives, enhancing wholeness (Snyder & Lindquist,
2002). Therefore, journal writing could be a useful practice for older
adults.
Despite much anecdotal and theoretical support, there is a paucity
of research to substantiate the value of journaling in the elderly. Brady
Creativity in Older Adults 399
and Sky (2003) conducted a qualitative study to explore past and cur-
rent journal writing practices of older learners with special attention to
questions of the perceived benefits of journaling in old age. They found
that most participants had kept a journal intermittently during their life-
time. A common pattern was to resume the practice of keeping a journal
because of a critical incident occurring in their life. Ten of the fifteen
participants reported being in favor of sharing their journals with others
or had already done so.
Brady and Sky (2003) categorized the benefits of journal writing as
the ability to cope, the joy of discovery, and the nurturing of voice and
spirit. Coping referred to functions that assisted the participants in their
day-to-day lives. Some ways that journaling helped them to cope were
self-therapy (identifying and working through feelings), sorting out is-
sues in relationships, helping make decisions, and compensating for poor
memory. The joy of discovery related to learning things about oneself
and one’s environment. Over half the participants reported that their
journals were a sort of milestone for ”measuring one’s own progress
in the journey of human development” (Brady & Sky, 2003, p. 159).
Participants also reported paying more attention and seeing things with
greater detail because of their practice of writing things down. The third
category, nurturing of voice and spirit, dealt with developing the confi-
dence that one has something meaningful to say. Writing regularly can
build confidence (Brady & Sky). Participants grew more confident as
they realized that they did have important things to say. A number of
participants explicitly referred to the quiet time that was required for
journaling and how these contemplative moments had helped to nurture
their spiritual lives.
One of the most compelling challenges of aging, according to Brady
and Sky (2003), is the quest to derive significance from years of lived
experience. “Experiences themselves do not have meaning until a person
reflects on, recollects, and interprets them. Writing has long been and
continues to be one of the most useful tools at the disposal of human
beings to do this important, reflective, and integrative work” (p. 161).
The study by Sky and Brady suggested multiple reasons that journal
writing would be useful in promoting successful aging. Through the
process of reflecting on and spending time writing down one’s thought
and feelings, an aging person could experience spiritual growth and
enrichment, exercise creativity, and work toward integration.
Another study that showed promise for journal writing in elders was
that of Campbell (1992). Campbell’s study was developed within Roy’s
Adaptation Model and involved elderly assisted living residents who
exhibited symptoms of depression. One aim of this study was to see
400 M. Flood and K. D. Phillips
whether nursing intervention strategies made a significant difference in
levels of depression in otherwise healthy elderly. All participants had
been identified as having depressive symptoms. Participants were as-
signed to one of three groups by stratified random sample according
to gender. The intervention treatment group received eight weeks of
individual therapy. A control group received no nursing interventions
and a third group received classes on crafts. Nursing intervention strate-
gies included cognitive therapy involving journaling and self-esteem
enhancement. Participants engaged in two one-hour sessions of individ-
ual therapy per week. This therapy included reviewing and discussing
the participants’ journals with the nurse and self-esteem enhancement.
Participants kept daily journals to record their thought patterns and en-
vironmental stimuli. The daily entries were sources for discussion and
clarifying thoughts and ideas the participants were experiencing. Nurses
encouraged reminiscence and focused on positive aspects of the past.
Participants enjoyed recounting memories of the past and roles played
during different stages of their life (Campbell, 1992). “Often the partici-
pants had negative thoughts about their past or present situation and did
not realize that these thoughts perpetuated feelings of depression” (p.
25). At the end of the eight-week intervention, all the participants in the
intervention treatment group scored below 60 on the Zung Depression
Scale, suggesting mild or no depression. The control group that received
no intervention showed no change from their initial score; Zung scores
remained above 69, showing moderate to severe depression. The dif-
ference in depression scores before and after the nursing interventions
was statistically significant, showing evidence of change (Campbell).
The group that received crafts instruction experienced a decrease in
their level of depression, from an average score of 72 to one of 68,
suggesting mild to severe depression. While Campbell’s study showed
promise for the use of journals in the elderly, several things must be con-
sidered. The journaling, individual therapy, or a combination of these
things might have been responsible for the reduced depression. Since in-
dividual therapy also emphasized self-esteem enhancement, self-esteem
interventions could have influenced participants’ depression. An inter-
esting outcome was the reduction in depression scores for the crafts
group. It is possible that enhanced creativity occurred and affected de-
pression scores in this group.
Reminiscence
One of the most frequently studied forms of creative activity is rem-
iniscence. Although it is not typically considered a creative activity,
Creativity in Older Adults 401
reminiscence does have some of the characteristics of creativity. Remi-
niscence may entail cognitive and emotional processes involved in the
conception of meaningful solutions to past problems. Reminiscence has
the potential to generate novel and useful associations, attributes, or ele-
ments, and produce a result (a new and different way of remembering the
past) not present before. Through recall of memories, older adults may
be able to identify innovative problem-solving strategies that enabled
them to survive difficult times. During the process of reminiscing, older
adults also may come up with different ways of remembering their past
by reframing life events. As a result of reminiscence, past conflicts can
be transformed into more stable and creative products. Reminiscing may
serve as a stimulus for new ways of thinking and doing things, as older
adults rethink past events where they (or others) used different strategies
to cope with situations.
Reminiscence has beneficial physiological effects as well; memories
are created when clusters of hundreds or thousands of neurons fire in
a unique pattern (Cohen, 2005). During recall (i.e., when one is pay-
ing attention), the connections between these neurons are automatically
strengthened; the more often a particular pattern is stimulated, the more
sensitive and permanent are the connections between the neurons in the
pattern (Cohen). Furthermore, autobiographical expression in later life,
such as telling about one’s past experiences, appears to be an example
of bilateral involvement of brain hemispheres (Cohen). This finding is
in contrast to recall of autobiographical events in younger adults, who
primarily use the left hippocampal region of the brain. Thus, reminiscing
could strengthen neural connections as well as exercise additional areas
of the brain in older adults.
Westerhof, Bohlmeijer, and Valenkamp (2004) conducted a study of
reminiscence in 57 older adults, who participated in 12 themed reminis-
cence sessions. The sessions consisted of structured reminiscence on top-
ics such as first memories and early scents, childhood houses, and friend-
ship. Personal meaning and depressive symptoms were measured pre-
and post-intervention. The SELE-instrument was used to assess personal
meaning (Dittmann-Kohli, 1995; Dittmann-Kohli & Westerhof, 1997).
The SELE-instrument is a sentence completion questionnaire consist-
ing of 28 sentence stems, that asks respondents to complete the stem by
expressing what he or she considers to be true and important about his-
or herself. Sentence stems are worded either positively, negatively, or
neutrally, and prompt cognitive interpretations of self and life. Exam-
ples of items are “I am proud that . . . ,” “My weaknesses are . . . ,” and
“When I think about myself . . . (Westerhof, Bohlmeijer, & Valenkamp,
2004). The Centre of Epidemiological Studies Depression scale
402 M. Flood and K. D. Phillips
(CES-D; Bouma, Ranchor, Sanderman, & van Sonderen, 1995) was
used to measure depressive symptoms.
When compared with a demographically matched group of older
adults from the Dutch Aging Survey (Steverink, Westerhof, Bode, &
Dittmann-Kohli, 2001), the reminiscence participants tended to be more
self preoccupied and have more negative personal meaning prior to the
intervention. Participants tended to have more positive personal mean-
ings after the intervention; systematic significant differences were found
in particular with regard to becoming less negative about the self and
social relationships (Westerhof, Bohlmeijer, & Valenkamp). The re-
searchers compared the three tertile groups of the sample, according
to change in depressive symptoms, and found that the group that did not
improve also showed no significant change in personal meaning. The
group whose depressive symptoms improved slightly mainly changed
meaning problems from social relationships to activities. The group
whose depressive symptoms improved slightly mainly changed from
problems with meaning related to social relationships, to problems with
meaning related to activities (Westerhof, Bohlmeijer, & Valenkamp).
Overall, participants were more positive after the program, as com-
pared to before, as evidenced by a medium sized standardized treatment
effect.
These findings are in line with Hsieh and Wang’s (2003) systematic
review of reminiscence research. Of 24 studies involving reminiscence,
the authors identified nine that involved older adults, were randomized
controlled trials, included some measure of depression, and had either
a control or a placebo group. Despite notable differences across the
studies in terms of methodology, characteristics of participants (i.e.,
some had diagnoses of depression and some did not), and interven-
tion protocols, reminiscence interventions appeared to have a positive
effect on depression. Treatment groups in two of the six studies had
significantly lower scores on depression as compared to a placebo con-
trol group; four out of eight studies with a standard care control group
showed significantly lower depression scores for the treatment group
post-intervention.
Wang (2004) investigated the effects of individual reminiscence ses-
sions in a sample of 48 Taiwanese older adults, half of whom were insti-
tutionalized and half of whom were community-dwelling. Individuals
participated in four months of once weekly one-on-one reminiscence ses-
sions with a researcher. Mental health indicators that were measured pre
and post intervention included self-esteem, perceived health, depression,
and emotional states. The Rosenburg Self-Esteem Scale, Health Percep-
tion Scale, Geriatric Depression Scale, and Apparent Emotion Rating
Creativity in Older Adults 403
Scale were administered to measure these constructs. Prior to the inter-
vention, there were no significant differences between the two groups
on any of the study variables. No significant differences were found be-
tween pre- and post-intervention tests in the non-institutionalized group.
However, for the institutionalized group, there were significant differ-
ences between pre- and post-intervention in perceived health, depressive
symptoms, and mood status. When the effectiveness of the reminiscence
intervention was measured by comparing mean post intervention scores
of the two groups, there was no significant difference in terms of self-
esteem, health perception, and depressive symptoms. However, there
wasasignificant difference between groups on mood status, suggesting
that the institutionalized group experienced a significant effect on mood
status after the intervention. These findings suggest that individual rem-
iniscence has a more powerful effect for older adults in institutions than
older adults who are not. It is possible that the effects in the institution-
alized group are attributable to the socialization and individual atten-
tion these participants, who may feel more isolated than those who are
community-dwelling, received. However, institutionalized older adults
are likely to be more fragile and sicker than those who remain inde-
pendent within the community. Therefore, it is also possible that the
health and psychosocial circumstances of the individual influence their
response to reminiscence.
Stinson and Kirk (2006) conducted an experimental study involving
a reminiscence and standard activity control group in an assisted living
facility. Twenty-four women ranging from 72 to 96 years in age partici-
pated. Depression was measured with the Geriatric Depression Scale and
self transcendence was measured with the Self Transcendence Scale, at
baseline, three, and six weeks. The intervention consisted of structured
group reminiscence sessions twice weekly for six weeks. At baseline,
four women (three controls and one standard treatment) were identified
as severely depressed. Eight women were identified as mildly depressed,
and twelve had no signs of depression. After the six week intervention,
there was no significant change in depression or self transcendence for
the treatment group, relative to the control group. Scores on the Geriatric
Depression Scale and the Self Transcendence Scale were stable across
time. However, there was a non-significant decrease in depression and
a non-significant increase in self transcendence in the treatment group
relative to the control group over time, indicating a positive result in
reminiscence group sessions. The small sample size in this study may
have obscured detection of intervention effects.
In terms of clinical projects, reminiscence has been shown to produce
positive outcomes in older adults. One such example is that of Harrand
404 M. Flood and K. D. Phillips
and Bolstetter (2000), who developed a community-based reminiscence
group for older adults. The goal of the structured-format reminiscence
intervention was health promotion. Session topics included childhood
memories, positive influences on one’s life, and hobbies. The impor-
tance of family heritage and the passage of values from generation to
generation, ethnic and racial heritage, poetry, and reading were some
of the central themes that emerged during groups. Participants unani-
mously agreed that the sessions were an enjoyable and positive experi-
ence. Harrand and Bollstetter noted positive outcomes from the project:
the group linked accomplishments of the past to the present, participants
unanimously agree that the sessions were an enjoyable and positive ex-
perience, and they talked about their cultural heritage, which were the
three goals of the project.
Another example of the clinical application of reminiscence is the
work of Nugent (1995), who used four case studies to illustrate how
reminiscence was effective in helping clients mobilize coping resources
to meet self-care demands by increasing self-esteem. Reminiscence was
used to increase self-esteem, develop coping skills, decrease anxiety,
and address altered self-concept in the case studies. Nugent concluded
that reminiscence was an effective intervention because each client met
his or her treatment goal.
Generally speaking, reminiscence has demonstrated positive out-
comes, and a few negligible ones. It is an inexpensive, low-risk in-
tervention and a novel way of facilitating creativity in older adults. In
addition to reminiscence, other creative methods have been investigated.
Research on a variety of types of groups has shown positive results for the
usefulness of creativity. In a group setting, new ideas can be generated,
group members can gain insight and new perspectives, and members
may be motivated to try new activities or inspired to come up with new
ways of thinking.
Groups
Phoenix, Irvine, and Kohr (1997) conducted a clinical project that
consisted of creative psychoeducational groups for older adult females.
The clinicians designed a series of 11 once-weekly group sessions. The
weekly sessions were based on Maynard’s (1993) model of integrated
theories, which had been used as the foundation for the development of
treatment methods in group work with women. The aim of their project
wastohelp older adult women learn to cope with depression. Prior
to beginning the intervention, the clinicians administered the Beck De-
pression Inventory, the Beck Anxiety Inventory, the Geriatric Depression
Creativity in Older Adults 405
Scale, and the Sheehan Disability Scale. Themes of the sessions were de-
pression, relationship of thoughts to depression, the role of social factors
in depression, goal setting, self-esteem, understanding family of origin,
assertiveness, stress management, caring for one’s body, wellness ed-
ucation, and termination. Each group session included an introduction
of the planned topic followed by group members’ sharing of relevant
personal stories.
After the series of group sessions was complete, the clinicians ad-
ministered the same set of instruments again. The intervention appeared
to be a somewhat helpful treatment modality for elderly women with
depression. A comparison of pre- and post-interventions scores for all
instruments showed that scores either stayed the same or improved. For
those participants whose scores remained the same, the clinicians noted
that these women had given anecdotal feedback that indicated their in-
terpersonal stressors had increased during the course of the project. Sub-
jective feedback from group members was positive; the women reported
feeling more assertive and having increased self-esteem.
The Aging Gracefully Program was implemented by the nursing fac-
ulty at Johns Hopkins University School of Nursing in response to the
health care needs of older adults living in low-income public housing.
This health education program utilized creative strategies in its goals
to focus on the more positive aspects of older adults’ lives, prevent so-
cial isolation, enhance positive health behaviors, and offer resources for
older adults to maintain independence despite the aging process (Gerson
& Berg, 2004). The clinicians’ innovative approach was comprised of
seven group sessions which were conducted every six to eight weeks.
Forevery session there was a particular theme and a specific approach.
The themes were identified by “consumer-friendly” titles (Gerson &
Berg, 2004). For example, the session titled “Holidays” was intended to
reduce feelings of isolation around holidays and acknowledge cultural
beliefs; participants were asked to think of something from the past.
Participants were invited to select a gift from the table of gifts and talk
about the memories evoked by the item. The clinicians used the story-
telling process to facilitate this activity. “Recognizing the Blues” was a
session to educate participants about signs of depression, and included
a film on depression. Other sessions covered coping with stress; coping
with physical changes of aging; redirecting one’s energy after a winter of
inactivity; clarifying decisions about end-of-life; and identifying strate-
gies used to create joy in life. The clinicians utilized group discussion
and list-making, story-telling, show and tell, reminiscence, films, and
old photographs during the group sessions to achieve session objectives.
Because this was a clinical project rather than research, the clinicians
406 M. Flood and K. D. Phillips
did not collect quantitative data. However, outcomes of increased social
interaction, increased participant responsiveness and group involvement,
improved demeanor, and positive anecdotal feedback suggested that the
project was successful.
THERAPEUTIC BENEFITS OF CREATIVITY
Psychosocial Benefits of Creativity
Creativity in the form of reminiscence, problem-solving activities,
group activities, production of artistic creations, poetry, and journal
writing has been explored. The research studies and clinical projects
that have examined these creative modalities have shown promising
evidence for the usefulness of creativity in older adulthood. Findings
suggest that creative activities can improve problem-solving ability,
self-esteem, coping skills, anxiety, internal locus of control, life sat-
isfaction, depressive symptoms, and hypochondriasis. Moreover, cre-
ative interventions have generally elicited positive anecdotal feedback
from older adult participants and stimulated their involvement and
responsiveness.
In addition to these investigations of creativity, an extensive compi-
lation of earlier studies has shown support for the benefits of creativity
in older adults (Hickson & Housely, 1997). The earlier research is con-
sistent with findings from the more recent creativity studies and clinical
projects; whether problem-solving or artful, process or product, creativ-
ity is beneficial for older adults. All of the older research and most of the
more recent work has demonstrated positive relationships between cre-
ativity and mental well-being of older adults. Thus, it is well established
that creativity is advantageous to the mental well-being of older adults.
Physiological Benefits of Creativity
In addition to these findings, more recent research has shown posi-
tive physiological benefits of creativity. Normal changes of aging in the
neurological system include decreased numbers of neurons with accu-
mulation of senile plaques and neurofibrillary tangles, decreased brain
size and weight, decreased blood flow to the brain, and decreased short
term memory (Tabloski, 2006). Neurons involved in memory and in-
tellectual function communicate with each other through dendrites and
through the release of neurotransmitters between the dendrites (Cohen,
2001). Research has shown that a stimulating environment results in
individual neurons developing new dendritic branches, which enhance
Creativity in Older Adults 407
neurotransmissions (Cohen). Thus, communications and connections
among neurons improve. Environmental stimulation of the brain results
in increased production of acetylcholine, the neurotransmitter most in-
volved in influencing memory and intellectual processes (Cohen). Re-
search also suggests that from the early fifth decade of life and into the
late seventies, the length of individual dendrites increases in different
parts of the brain (Flood & Coleman, 1990). Other findings reveal that
from the early fifties to the late seventies there is an increase in dendritic
growth at the ends of individual neurons in different areas of the cere-
bral cortex (Flood et al., 1985). Therefore, despite adverse neurological
changes that are part of the aging process, some positive changes still
occur into the seventh decade. With adequate stimulation it is possi-
ble to promote these positive alterations and compensate for age-related
neurological declines.
Outside the central nervous system, other positive neurological events
also occur as a consequence of creative activity. When the brain engages
in creative work, it alerts the parasympathetic nervous system; heart rate
and breathing slow, blood pressure decreases, blood circulation to the
intestines increases, and the body shifts into relaxation (Samuels & Lane,
1998). Creative activities also stimulate the hypothalamus to activate the
autonomic nervous system, stabilizing and maintaining blood flow, heart
rate, and hormone levels (Lane, 2005). Furthermore, engaging in creative
activity can stimulate the release of endorphins from specific areas of
the brain, affecting brain cells and the immune system and improving
their function (Lane).
Research on the clinical effects of creative interventions has shown
positive results. For example, placement of art in intensive care units
helps to relax patients; they use less pain medication and are discharged
earlier than patients who do not have artwork in their rooms (Kreitzer &
Snyder, 2002). Therefore, creative modalities could have multiple uses
for older adults, such as improvement of neurological and cognitive
function, increased (muscular as well as psychological) relaxation, and
alleviation of discomfort. A specific example of a creative interventions
is incorporating art into therapies; nurses might explore activities such
as drawing or writing, that patients have done in the past or have an
interest in trying, and encourage participation in these things as a leisure
activity or a means of self exploration. Joining a group of some kind
might stimulate more innovative and divergent thinking in older adults.
Opportunities for group participation are numerous: senior centers, sup-
port groups, church groups, and volunteer organizations are just a few
examples of groups in which older adults could become involved. Al-
though they may be aware of such opportunities within their community,
408 M. Flood and K. D. Phillips
older adults probably are not aware of the many therapeutic benefits that
come with group involvement. In addition to the psychosocial and phys-
iological benefits, creative interventions, like art and group work, offer
other advantages for the older adult. Leaving the home for participation
in a creative activity permits some degree of physical exercise, exposure
to fresh air, and sunlight. Also, increasing one’s mobility can encourage
appetite, circulation, and bowel elimination. Furthermore, some older
adults may be more receptive to enjoyable activities that provide a social
opportunity, than to medications and psychotherapy. Due to social stigma
and values of their generation, some older adults still resist psychiatric
care, despite the presence of psychiatric symptoms and emotional dis-
tress. While this is not a suggestion that creative activity should take the
place of psychiatric treatment, it might offer some help to older adults
who might otherwise not accept treatment, and could also supplement
routine care.
CONCLUSION
This literature review illustrates several important facets of creativ-
ity. When asked, older adults emphasize the relevance of mental health
characteristics and transcendence when describing creativity (Fisher &
Specht, 1999). The definitions of creativity from the works reviewed
suggest that we broaden our conceptualization of creativity to include
some group work and reminiscence in addition to the more traditional
artistic forms of creativity. In addition to older adults’ enjoyment, the
physiological benefits of creativity, combined with the mental health
advantages, are key reasons for the use of creative activities in older
adults. Cohen’s (2006) findings provide overwhelming support for this
notion, linking the engaging nature, physical, and mental health benefits
of creativity. Examining the relationships among creativity levels, men-
tal health indicators, and physiological indicators has yet to be done. One
recommendation for future creativity research is to investigate the rela-
tionship among creativity levels, mental health, and autonomic nervous
system functioning (evidenced by blood pressure, heart rate, immunity,
etc.). The possibilities for future research are many and it is exciting to
think of the many therapeutic effects that creative activities can have for
older adults.
Landau and Moaz (1978) relate creativity to self-actualization, stat-
ing that through creative decision-making, self-actualization is possible.
“The creative personality is emotionally free, responsive, and flexible in
its approaches” (Landau & Moaz, 1978, p. 118). So, too, must creativity
research be. Creativity research in older adults is still in its early stages;
Creativity in Older Adults 409
with a creative mindset, there are a plethora of possibilities for creative
activities in older adults.
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