Thursday, February 13, 2014

Creativity in Older Adults: Learning Digital Photography Improves Cognitive Function

The unprecedented increase in the mean life expectancy during the past centuries and a concomitant drop in the birth rate has resulted in a major demographic shift in most parts of the world. The proportion of fellow humans older than 65 years of age is higher than at any time before in our history. This trend of generalized population ageing will likely continue in developed as well as in developing countries. Population ageing has sadly also given rise to ageism, prejudice against the elderly. In 1950, more than 20% of citizens aged 65 years or older participate used to participate in the labor workforce of the developed world. The percentage now has dropped to below 10%. If the value of a human being is primarily based on their economic productivity – as is so commonly done in societies driven by neoliberal capitalist values – it is easy to see why prejudices against senior citizens are on the rise. They are viewed as non-productive members of society who do not contribute to the economic growth and instead represent an economic burden because they sap up valuable dollars required to treat chronic illnesses associated with old age.

In "Agewise: Fighting the New Ageism in America", the scholar and cultural critic Margaret Morganroth Gullette ties the rise of ageism to unfettered capitalism:
There are larger social forces at work that might make everyone, male or female, white or nonwhite, wary of the future. Under American capitalism, with productivity so fetishized, retirement from paid work can move you into the ranks of the "unproductive" who are bleeding society. One vile interpretation of longevity (that more people living longer produces intolerable medical expense) makes the long-lived a national threat, and another (that very long-lived people lack adequate quality of life) is a direct attack on the progress narratives of those who expect to live to a good old age. Self-esteem in later life, the oxygen of selfhood, is likely to be asphyxiated by the spreading hostile rhetoric about the unnecessary and expendable costs of "aging America".
Instead of recognizing the value of the creative potential, wisdom and experiences that senior citizens can share with their respective communities, we are treating them as if they were merely a financial liability. The rise of neo-liberalism and the monetization of our lives are not unique to the United States and it is likely that such capitalist values are also fueling ageism in other parts of the world. Watching this growing disdain for senior citizens is especially painful for those of us who grew up inspired by our elders and who have respected their intellect and guidance they can offer.

In her book, Gullette also explores the cultural dimension of cognitive decline that occurs with aging and how it contributes to ageism. As our minds age, most of us will experience some degree of cognitive decline such as memory loss, deceleration in our ability to learn or process information. In certain disease states such as Alzheimer's dementia or vascular dementia (usually due to strokes or ‘mini-strokes'), the degree of cognitive impairment can be quite severe. However, as Gullete points out, the dichotomy between dementia and non-dementia is often an oversimplification. Cognitive impairment with aging represents a broad continuum. Not every form of dementia is severe and not every cognitive impairment – whether or not it is directly associated with a diagnosis of dementia – is global. Episodic memory loss in an aging person does not necessarily mean that the person has lost his or her ability to play a musical instrument or write a poem. However, in a climate of ageism, labels such as "dementia" or "cognitive impairment" are sometimes used as a convenient excuse to marginalize and ignore aged fellow humans.

Perhaps I am simply getting older or maybe some of my academic colleagues have placed me on the marketing lists of cognitive impairment snake oil salesmen. My junk mail folder used to be full of emails promising hours of sexual pleasure if I purchased herbal Viagra equivalents. However, in the past months I have received a number of junk emails trying to sell nutritional supplements which can supposedly boost my memory and cognitive skills and restore the intellectual vigor of my youth. As much as I would like strengthen my cognitive skills by popping a few pills, there is no scientific data that supports the efficacy of such treatments. A recent article by Naqvi and colleagues reviewed randomized controlled trials– the ‘gold standard' for testing the efficacy of medical treatments – did not find any definitive scientific data that vitamin supplements or herbs such as Ginkgo can improve cognitive function in the elderly. The emerging consensus is that based on the currently available data, there are two basic interventions which are best suited for improving cognitive function or preventing cognitive decline in older adults: regular physical activity and cognitive training.

Cognitive training is a rather broad approach and can range from enrolling older adults in formal education classes to teaching participants exercises that enhance specific cognitive skills such as improving short-term memory. One of the key issues with studies which investigate the impact of cognitive training in older adults has been the difficulty of narrowing down what aspect of the training is actually beneficial. Is it merely being enrolled in a structured activity or is it the challenging nature of the program which improves cognitive skills? Does it matter what type of education the participants are receiving? The lack of appropriate control groups in some studies has made it difficult to interpret the results.

The recent study "The Impact of Sustained Engagement on Cognitive Function in Older Adults: The Synapse Project" published in the journal Psychological Science by the psychology researcher Denise Park and her colleagues at the University of Texas at Dallas is an example of an extremely well-designed study which attempts to tease out the benefits of participating in a structured activity versus receiving formal education and acquiring new skills. The researchers assigned subjects with a mean age of 72 years (259 participants were enrolled, but only 221 subjects completed the whole study) to participate in 14-week program in one of five intervention groups: 1) learning digital photography, 2) learning how to make quilts, 3) learning both digital photography and quilting (half of the time spent in each program), 4) a "social condition" in which the members participated in a social club involving activities such as cooking, playing games, watching movies, reminiscing, going on regular field trips but without the acquisition of any specific new skills or 5) a "placebo condition" in which participants were provided with documentaries, informative magazines, word games and puzzles, classical-music CDs and asked to perform and log at least 15 hours a week of such activities. None of the participants carried a diagnosis of dementia and they were novices to the areas of digital photography or quilting. Upon subsequent review of the activities in each of the five intervention groups, it turned out that each group spent an average of about 16-18 hours per week in the aforementioned activities, without any significant difference between the groups. Lastly, a sixth group of participants was not enrolled in any specific program but merely asked to keep a log of their activities and used as a no-intervention control.

When the researchers assessed the cognitive skills of the participants after the 14-week period, the type of activity they had been enrolled in had a significant impact on their cognition. For example, the participants in the photography class had a much greater degree of improvement in their episodic memory and their visuospatial processing than the placebo condition. On the other hand, cognitive processing speed of the participants increased most in the dual condition group (photography and quilting) as well as the social condition. The general trend was that the groups which placed the highest cognitive demands on the participants and also challenged them to be creative (acquiring digital photography skills, learning to make quilts) showed the greatest improvements.

However, there are key limitations of the study. Since only 221 participants were divided across six groups, each individual group was fairly small. Repeating this study with a larger sample would increase the statistical power of the study and provide more definitive results. Furthermore, the cognitive assessments were performed soon after completion of the 14-week programs. Would the photography group show sustained memory benefits even a year after completion of the 14-week program? Would the participants continue to be engaged in digital photography long after completion of the respective courses?

Despite these limitations, there is an important take-home message of this study: Cognitive skills in older adults can indeed be improved, especially if they are exposed to an unfamiliar terrain and asked to actively acquire new cognitive skills. Merely watching educational documentaries or completing puzzles ("placebo condition") is not enough. This research will likely spark many future studies which will help define the specific mechanisms of how acquiring new skills leads to improved memory function and also studies that perhaps individualize cognitive training. Some older adults may benefit most from learning digital photography, others might benefit from acquiring science skills or participating in creative writing workshops. This research also gives us hope as to how we can break the vicious cycle of ageism in which older citizens are marginalized because of cognitive decline, but this marginalization itself further accelerates their decline. By providing opportunities to channel their creativity, we can improve their cognitive function and ensure that they remain engaged in the community.

There are many examples of people who have defied the odds and broken the glass ceiling of ageism. I felt a special sense of pride when I saw my uncle Jamil's name on the 2011 Man Asian Literary Prize shortlist for his book The Wandering Falcon: He was nominated for a ‘debut' novel at the age of 78. It is true that the inter-connected tales of the "The Wandering Falcon" were inspired by his work and life in the tribal areas of the Pakistan-Afghanistan borderlands when he was starting out as a young civil servant and that he completed the first manuscript drafts of these stories in the 1970s. But these stories remained unpublished, squirreled away and biding their time until they would eventually be published nearly four decades later. They would have withered away in this cocooned state, if it hadn't been for his younger brother Javed, who prodded the long-retired Jamil, convincing him to dig up, rework and submit those fascinating tales for publication. Fortunately, my uncle found a literary agent and publisher who were not deterred by his advanced age and recognized the immense value of his writing.

When we help older adults tap into their creative potential, we can engender a new culture of respect for the creativity and intellect of our elders.

Further Reading:
  1. Gullette, Margaret Morganroth. Agewise: Fighting the new ageism in America. University of Chicago Press, 2011.
  2. Naqvi, Raza et al "Preventing cognitive decline in healthy older adultsCMAJ July 9, 2013 185:881-885.doi: 10.1503/cmaj.121448
  3. Park, Denise C et al "The Impact of Sustained Engagement on Cognitive Function in Older Adults", published online on Nov 8, 2013 in Psychological Science doi:10.1177/0956797613499592
Note: An earlier version of this article was first published on Park DC, Lodi-Smith J, Drew L, Haber S, Hebrank A, Bischof GN, & Aamodt W (2014). The impact of sustained engagement on cognitive function in older adults: the synapse project. Psychological science, 25 (1), 103-12 PMID: 24214244

1 comment:

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