Lessons from the Literature

2020; Volume 21, No 1, January

Lessons from the Literature

Under My Microscope

Dr. Tania Pastrana. Used with permission.

IAHPC Research Advisor Dr. Tania Pastrana selects one article from recently published medical literature and describes why it is worthwhile.

The Art of Life and Death: 14 year follow-up analyses of associations between arts engagement and mortality in the English Longitudinal Study of Ageing

D Fancourt, A Steptoe. BMJ 2019: 367; 16377. DOI: 10.1136/bmj.16377

At the beginning of the year, we reflect upon our lifestyle and new purposes arise. In 2020, I invite you to add the consumption of fine arts to your “To-do” list. Though intrinsically esthetic in nature, the fine arts confer psychological, physical, social, and behavioral benefits, along with other, lesser-known beneficial impacts on quality of life.

This article, based on a 14-year follow-up study of a nationally representative sample of 6,710 adults aged 50 and older in England [English Longitudinal Study of Ageing (ELSA)], looked at the impact of the arts on longevity. Fancourt and Steptoe observed that people who engaged with arts activities — such as going to museums, art galleries, exhibitions, the theatre, concerts, or the opera — on an infrequent basis (once or twice a year) had a 14% lower risk of dying at any point during the follow-up. Those who engaged more frequently had a 31% lower risk of dying in the same period of time, independent of demographic, socioeconomic, health related, behavioral, and social factors.

I wish you (both those over and under 50 years of age) longer and happier lives, with fine arts!

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Objective: To explore associations between different frequencies of arts engagement and mortality over a 14 year follow-up period.

Design: Prospective cohort study.

Participants: English Longitudinal Study of Ageing cohort of 6,710 community dwelling adults aged 50 years and older (53.6% women, average age 65.9 years, standard deviation 9.4) who provided baseline data in 2004-2005.

Intervention: Self-reported receptive arts engagement (museums, art galleries, exhibitions, the theatre, concerts, the opera).

Measurement: Mortality measured through data linkage to the National Health Service central register.

Results: People who engaged with receptive arts activities on an infrequent basis (once or twice a year) had a 14% lower risk of dying at any point during the follow-up (809/3,042 deaths, hazard ratio 0.86, 95% confidence interval 0.77 to 0.96) compared with those who never engaged (837/1,762 deaths). People who engaged with receptive arts activities on a frequent basis (every few months or more) had a 31% lower risk of dying (355/1,906 deaths, 0.69, 95% confidence interval 0.59 to 0.80), independent of demographic, socioeconomic, health related, behavioral, and social factors. Results were robust to a range of sensitivity analyses with no evidence of moderation by sex, socioeconomic status, or social factors. This study was observational and so causality cannot be assumed.

Conclusions: Receptive arts engagement could have a protective association with longevity in older adults. This association might be partly explained by differences in cognition, mental health, and physical activity among those who do and do not engage in the arts, but remains even when the model is adjusted for these factors.

Do you have any questions regarding Under My Microscope?

Contact Tania Pastrana

Media Watch: Indigenous Peoples

Indigenous peoples present unique challenges in the provision and delivery of palliative and end-of-life care. Sensitivity to cultural distinctions and linguistic differences is paramount, as is respect for beliefs, values, and end-of-life practices. The articles below are selected from Barry R. Ashpole’s weekly report, Media Watch.

Key features of palliative care service delivery to Indigenous peoples in Australia, New Zealand, Canada and the U.S.: A comprehensive review

BMC Palliative Care | Online – 8 May 2018 –This review highlights the key features of culturally safe service delivery that have been reported to be working well in the Indigenous PC context. “Good care” is defined by those receiving the care, and not those who provide it. A flexible approach, adaptability to the context and “buy-in” from local communities are reported to be some of the essential features of successful service models to deliver PC services to Indigenous populations, and the literature emphasizes that a “one size fits all” approach is not appropriate. This flexibility must incorporate family involvement in decision-making and extend to the referral process, such that family members are able to refer patients to specialist PC services. McGrath et al reiterate that, “a static model … [should not] be imposed on services or communities but rather a living, flexible model is required to assist with service delivery and health policy.” Flexibility in these settings also augments Indigenous representation and retention within the health workforce. DOI: 10.1186/s12904-018-0325-1

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Also of interest: Cultural safety strategies for rural Indigenous palliative care: A scoping review. The authors’ review about Indigenous palliative care in rural and small-town settings in Australia, Canada, New Zealand and the U.S. reveal strategies to improve its relevance and cultural appropriateness.

The Evolution of Palliative Care within the American Indian Health System

Cancer Health Disparities | Online – 21 July 2018 –This article recounts the efforts made over many years to institute quality PC programs that are culturally acceptable to native populations, and outlines “next steps.” DOI: 10.9777/chd.2018.10006

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Also of interest: A Review of the Literature on Native Hawaiian End-of-Life Care: Implications for research and practice [Note: Download the whole issue to access the full text.]

Passing On Wisdom: Exploring the end-of-life wishes of Aboriginal people from the Midwest of Western Australia

Rural & Remote Health, 2019; 19(4). Indigenous patients with life-limiting conditions have complex needs, experience reduced access to, and uptake of, treatment and have lower utilization of palliative care (PC) services than the general population. Lack of understanding of the role of PC and poor availability of culturally safe specialist PC services impact on Indigenous people’s end-of-life (EoL) decision-making. Aboriginal people were engaged to talk frankly about their wishes and concerns around EoL. The community consultations raised considerable discussion about wills, where to die, burial versus cremation, and the cost of funerals. Possibilities emerging from participants’ reflections on the issue were public celebrations to honour someone’s life, the potential use of sorting cards to help discussions about EoL personal wishes, and interest in making and decorating coffins. Within a safe space, Aboriginal people were happy to talk about EoL wishes, although certain aspects of death remain contentious. DOI: 10.22605/RRH5444

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Cultural health literacy: The experiences of Māori in palliative care

Global Health Promotion, 2018; 25(4): 15-23. ...More than sharing information was the question of whether the inherent context of hospices and other palliative care services were compatible with the Māori worldview. For some participants, the differences in the aims of such care were insurmountable, and they either chose not to receive care or delayed accessing services until the last possible moment. Patients and whānau [family] developed complex health literacy practices to work around the cultural and communication barriers demonstrated by the palliative care environment. DOI: 10.1177/1757975918764111

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Media Watch monitors the literature and the lay press on issues specific to the quality of end-of-life care. It is international in scope and distribution. View current and back issues here.

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