Systematic review of arts and culture-based interventions for people living with dementia and their caregivers

Creative support: Enhancing well-being in mild and moderate cognitive impairment through museum interventions

BackgroundThe global incidence of dementia is increasing, establishing it as a significant cause of disability and diminished quality of life. The World Health Organization underscores the necessity of enhancing the well-being of individuals with dementia and their caregivers. Research has indicated that art-based interventions can improve cognitive functions and overall quality of life. This pilot study aimed to evaluate the impact of a museum-based intervention program on the well-being (quality of life, depression, and mood) of individuals with mild-to-moderate cognitive impairment (MCI-moderate), which may indicate early to moderate stages of dementia that was not formally diagnosed.MethodsWe recruited 29 participants with MCI-moderate (median MoCA score: 22). The intervention group consisted of 16 individuals (11 females, 5 males; mean age 83.5 years) who attended sessions at an art museum in Israel every once a week from March to April 2023. Thirteen age-matched individuals formed the control group, which did not participate in the museum program. Measures of well-being were assessed before and after the intervention, along with collecting participants' feedback. Well-being changes within and between-groups were analyzed using mixed model analysis of variance. Effect sizes were also calculated.ResultsThe intervention group showed significant improvements in quality of life with large effect sizes in all domains, and a significant reduction in depression symptoms; the control group experienced non-significant changes. Additionally, mood significantly improved following museum activities. Most participants positively reviewed the program, with a significant majority reporting enhanced mood (81.2%) and a strong intention to recommend it (93.7%); 62.5% expressed a desire for future participation.ConclusionsOur findings suggest that art interventions, such as museum programs, can significantly boost well-being in people with MCI-moderate, suggesting further exploration of the specific elements of such programs and their long-lasting effects.

An Evidence-Based Framework for the Use of Arts and Culture in Public Health

ObjectivesIn recent years, increasing efforts have been made to apply arts- and culture-based strategies to public health concerns. Accumulating studies point to the value of these strategies for addressing social determinants of health in ways that center communities, cultures, and lived experiences. However, this work has lacked a common framework to support application and advancement. The objectives of this study were to examine knowledge, experience, and evidence related to the uses of arts and culture in public health in the United States and to develop a pilot version of an evidence-based framework to guide cross-sector development and research.MethodsUsing a convergent mixed-methods design with sequential elements, this study drew upon findings from a national field survey, seven focus groups, eight structured working-group dialogues, and a five-day structured dialogue and writing process with 12 interdisciplinary thought leaders. Data were integrated to develop a pilot evidence-based framework.ResultsThe study identified six broad ways in which arts and culture can be used in public health and 59 specific outcomes that can be addressed through arts and cultural strategies. The framework identifies evidence supporting the effects of arts and culture on each outcome, along with mechanisms that may mediate or moderate these effects.ConclusionThe pilot framework clearly links arts and culture practices with public health outcomes. In doing so, it provides both a resource for current practice and a model for the continued development of interdisciplinary tools that support health researchers and practitioners in utilizing arts and culture resources to advance community health and health equity.

Barriers and facilitators to accessing and engaging with arts-based non-pharmacological interventions for people living with dementia: A systematic review

Background and AimsNon-pharmacological arts interventions are increasingly being recognised as effective and beneficial ways to support and improve cognition and general well-being for people with dementia. However, accessing and engaging with beneficial arts interventions and support services can be challenging for people with dementia and their carers and it is important to understand barriers and facilitators that may impede access. This systematic review aimed to synthesise evidence on the barriers and facilitators to accessing and engaging with arts interventions and services for people living with dementia.MethodsWe systematically searched five electronic databases (PubMed, PsycINFO, CINAHL, Scopus, Web of Science) for studies reporting barriers and facilitators to accessing and engaging with arts interventions for people with dementia in July 2024, screening a total of 7815 articles. Nineteen papers were deemed eligible for inclusion in this review including 567 people with dementia, 320 unpaid carers and 355 paid carers.ResultsThis review highlights key facilitators and barriers to accessing and engaging with arts interventions for people with dementia. Key facilitators included the assistance of volunteers, the inclusion of unpaid carers in the sessions, and the effective facilitation of sessions. Barriers to access and engagement were identified for people with dementia and their unpaid carers such as increased reliance on unpaid carers and a lack of training and time for paid carers.ConclusionsIncreased awareness of these barriers and facilitators could aid in designing future arts interventions and support services to promote wider access and engagement for people with dementia and their carers.

Improving Collaboration Between Staff, Family Members, and Artists in Long-Term Dementia Care: A Participatory Action Research Project Into Health Care Clowning

A growing amount of evidence shows the positive impact of arts-based interventions in dementia care. Existing studies focus on the impact of such interventions on individuals with dementia, yet there is little known about contextual factors influencing the impact of such practices. Contextual factors include personal and relational processes, such as the collaboration between staff, family members, and artists. It also includes making specific organizational choices about the way in which arts and care organizations structure and organize their collaboration. The study aimed to investigate contextual factors influencing the potential impact of health care clowning for persons with dementia. Through multi-country participatory action research (PAR) into health care clowning in dementia care, this study engaged artists (health care clowns), staff, family members, and representatives from four long-term dementia care facilities and three health care clowning organizations. The presented findings show that for arts-based interventions to have sustainable impact within the context of long-term dementia care, focusing on the intervention itself is not enough. Additional time and space are needed for implementation of the intervention and good collaboration on the work floor. The results of this study demonstrate that elements in the PAR process such as open dialogue and arts-based research methods can create communicative spaces which can serve as a catalyst for effective implementation of arts-based practices in long-term dementia care. Elements of the PAR process can therefore be regarded as a form of successful boundary work and in the future could be applied when implementing arts-based interventions in care settings.

Reassessing the goals of musical activities for people living with dementia: Supporting joint agency, selfhood and couplehood with an embodied and relational approach

A risk present in medically informed psychosocial interventions for dementia, including musical interventions, is the potential to overly prioritise the reduction of cognitive decline, which can inadvertently emphasise deterioration and loss of skills and capacities. This focus can lead to disempowering people living with dementia rather than supporting and building on the skills that remain. In this paper, we present approaches linked with a more positive outlook on dementia, examining the strengths that continue in people living with dementia, as evidenced by how they engage in musical activities. We pay specific attention to how people living with dementia use embodied and relational ways of being and interacting with others, as well as the benefits that musical engagement can provide to selfhood, couplehood and agency in a context of change and adaptation due to the development of the condition. We propose a shift in perspective that takes advantage of music's affordances for embodied communication and connection, recognising people living with dementia as active agents with strengths in habituated ways of acting. With this shift we examine how couples can scaffold each other's abilities to reach towards a balanced sense of reciprocity. To further support this balanced reciprocity through embodied and relational aspects of musical participation, we make a proposal for the design of assistive music technologies that will support notions of we-perspective, joint agency and joint action, with each of these providing wellbeing benefits for people living with dementia and their carers. Drawing on the potential effects that embodiment and relationality have on agency, selfhood and couplehood in musical engagement, we present a case for reassessing the goals and design of musical activities and the technologies to support them.

[Effects of museum-based community programs on people with dementia and their primary caregivers-An umbrella review]

BACKGROUND

There has been noticeable research emphasis on the effects of museum-based programs as valuable community support for people with dementia and their primary caregivers.

RESEARCH QUESTION AND AIM

This umbrella review outlines the effects of museum-based community programs on health-related aspects of people with dementia and their primary caregivers and aims to synthesise existing evidence of museum-based programs and give directions for practice and implementation research.

METHOD AND MATERIAL

An umbrella review was undertaken following the guideline of the Joanna Briggs Institute (JBI). Therefore 6 databases (CINAHL Complete, PubMed, Medline Complete, SocINDEX, Psych & Behav Sci and the Cochrane Database for Systematic Reviews) were searched for systematic reviews and meta-analyses in April/May 2023 and as a follow-up in October 2023. The results were critically appraised by three reviewers.

RESULTS

A total of five systematic reviews and one meta-analysis were identified. Due to the heterogeneity of the primary studies no consistent statistically robust proof of effects of museum-based community programs currently exists. Qualitative studies support the effects towards improvement of quality of life, mood and other noncognitive parameters.

DISCUSSION AND CONCLUSION

While the heterogeneity of study designs prevents a critical evaluation of the effects and therefore a reliable comprehensible analysis, the results from different studies, including randomized controlled trials, support museum-based programs as a valuable resource for participation in day to day care and social prescribing. For future research adapted and extended methodological considerations and approaches, such as mixed methods designs are recommended.

What are the research priorities in dance for dementia? A co-created agenda to support equitable research

BACKGROUND

There is a gap in the field of dance for dementia regarding how to engage in and improve equitable, moral, and rights-based ways of working with those with lived experience to co-design research priorities. We set out to create a collaborative research agenda for this field.

METHODS

A series of collaborative activities were conducted, including an in-person workshop (n = 59 people), online workshop (n = 23 people), digital communications, podcasts, and co-writing, including with people living with dementia (PLWD), health and social care professionals, artists, arts organisational representatives, and academic researchers.

RESULTS

Three key themes were constructed: 1) Improving access to dance participation; 2) Prioritising co-produced approaches; and 3) Enabling innovation in measurement and methods.

CONCLUSION

This is the first co-produced agenda for the field of dance for dementia. Underpinned by diverse perspectives and lived experience, it outlines themes and associated research questions that can be used in future research.

Meaning-making of dementia caregiving: A systematic review of qualitative studies

BACKGROUND

Being the backbone of informal care for people living with dementia, caregivers suffer overwhelming physical and psychological challenges in their daily caregiving experience. Proactive coping strategies to alleviate the caregiving burden are of utmost importance. Meaning-making emerges as an effective coping approach to benefit caregivers and mitigate their care burden. However, the conceptualisation of meaning-making on its dimensions and process has been ambiguously identified.

OBJECTIVES

To synthesise the qualitative research evidence on meaning-making in a dementia context to identify: (1) the situational dimension in making sense of caregiving scenarios, and (2) how the meaning-making process evolves during dementia caregiving.

METHODS

This systematic review identified 62 qualitative studies published between 1969 and 2022 from the major databases. Eligible studies met the following inclusion criteria: (1) having informal caregivers of people living with dementia; (2) involving meaning-making of care experience; (3) adopting qualitative design; and (4) full-text of research articles. The risk of bias was evaluated using the Clinical Appraisal Skills Programme checklist. By using Qualitative Evidence Synthesis, themes relevant to critical dimensions and phases of meaning-making were generated from the extracted data.

RESULTS

Sixty-two studies involving 2487 subjects were synthesised investigating the critical dimensions and process of meaning-making of dementia care experience. Results indicated that the dementia care experience can be made sense of in several folds: (1) it involved complicated demands from people living with dementia and requires customised care; (2) the dynamics of dyadic interactions with dilemma and ambivalence; and (3) adaptive coping encapsulating perceptions of loss and growth, complied and integrated values, balanced expectations of care and self, and improvement in self-efficacy. The meaning-making process underwent phases of meaning creation (meaning created in initial encounter with dementia symptoms), meaning appraisal (assimilation and accommodation pathways for appraisal), and meaning adherence (integration of the appraised meanings).

CONCLUSION

Findings suggest meaning-making of dementia caregiving is a multi-faceted and multi-phased recursive process. Future implications give directions on the facilitation of meaning-oriented interventions to enhance the awareness of caregiving role and the knowledge of dementia care, learn techniques of reframing and restructuring, and seek meaningful perspectives; and to adopt strategies to overcome the barriers for meaning-making by empowering self-identity, roles and expectations, and the dyadic relationship. In addition, our findings inform future advancement in the conceptualisation and measurement of meaning-making in the context of family caregiving. Optimisation of the meaning-making process inspires professional assistance to enhance caregivers' coping for dementia care experience.

Dementia care and prevention in community settings: a built environment framework for cognitive health promotion

PURPOSE OF REVIEW

Most people with dementia live in the community. As lifespan increases, one in three persons aged 85+ are expected to live with dementia. We conduct a systematic search to identify frameworks for dementia care and prevention in community settings. This is important to ensure quality of life for people living with cognitive decline (PLCD).

RECENT FINDINGS

61 frameworks are synthesized into the dementia care and prevention in community (DCPC) framework. It highlights three levels of provision: built environment and policy supports, access and innovation, and inclusion across stages of decline. Domains of intervention include: basic needs; built environment health and accessibility; service access and use; community health infrastructure; community engagement; mental health and wellbeing; technology; end-of-life care; cultural considerations; policy, education, and resources. Personhood is not adequately represented in current built environment frameworks. This is supplemented with 14 articles on lived experiences at home and social practices that contribute to PLCD's social identity and psychological safety.

SUMMARY

Policy makers, health and built environment professionals must work together to promote "personhood in community" with PLCD. Clinicians and community staff may focus on inclusion, social identity and a sense of at-homeness as attainable outcomes despite diagnosis.

Care needs assessment of older adults with dementia in a semi-rural district in Vietnam: A community-based cross-sectional study

BACKGROUND

The increasing needs of people living with dementia (PLWD) in Vietnam present an enormous public health challenge. Vietnam is an understudied country, and little is known regarding the overall unmet needs of caregivers or the demographic risk factors associated with unmet caregiving needs. This study aimed to determine the burden of unmet care needs of community-dwelling PLWD and identify sociodemographic risks associated with unmet care needs.

METHODS

A cross-sectional study in a rural area facing urbanisation in Hanoi, Vietnam recruited PWLD-caregiver dyads with multistage sampling. We utilised the Camberwell Assessment of Need for the Elderly (CANE) instrument to evaluate care needs across four domains. Caregivers rated PLWD needs, with higher scores indicating greater unmet needs. The Mann-Whitney test was employed for comparing two groups, while the Kruskal-Wallis test was used for comparisons involving more than two groups in the analysis, and a P-value of less than 0.05 was considered statistically significant.

RESULTS

Among 90 PLWD participating in the study, the overall mean care needs score was 11.6 ± 4.3, with only 16.2% of PLWD having their care needs met. Environmental and physical needs were more frequently met than psychological or social needs. Only 48.0% and 43.9% of environmental and physical needs were met respectively, and a meagre 20.9% and 23.6% for psychological and social needs. Unmet care needs were more frequent for PWLD who were female, single or divorced, had lower monthly household income, or who were in more advanced stages of dementia, as indicated by Clinical Dementia Rating scores ≥1.

CONCLUSIONS

Unmet needs for PWLD are common. Increased caregiver education, resources, and services in Vietnam are urgently required to improve the quality of life for this population.

Dyadic Art Appreciation and Self-Expression Program (NCGG-ART) for People with Dementia or Mild Cognitive Impairment and Their Family Caregivers: A Feasibility Study

BACKGROUND

Non-pharmacological interventions effective for depressive mood and bilateral relationships among persons with cognitive impairment (PwCI) and their family caregivers (FCGs) have not been established.

OBJECTIVE

To examine the feasibility of a newly developed group-based art appreciation and self-expression program (NCGG-ART) for dyads of PwCI and their FCGs.

METHODS

This pilot randomized control trial included 34 dyads of PwCI diagnosed with mild to moderate Alzheimer's disease or mild cognitive impairment, and their FCGs, from an outpatient rehabilitation service (Holistic Physio-Cognitive Rehabilitation [HPCR]). Participants were randomly divided equally into the HPCR (control group) or NCGG-ART and HPCR (intervention group) groups. Both included 1-hour weekly, 6-week programs. The primary outcome was depressive symptoms among FCGs assessed using the Patient Health Questionnaire-9 (PHQ-9). Feasibility outcomes included participant satisfaction and motivation. FCGs were interviewed about their experiences and feelings regarding the program, which were analyzed using content analysis.

RESULTS

Thirty-two dyads (intervention group:16; control group:16) completed the study period. High participation rates, satisfaction, and motivation were demonstrated throughout the intervention. Scores in the PHQ-9 among FCGs did not show positive effects: mean changes in the score were 1.3 for the intervention group and -0.8 for the control group (Cohen d:0.56). However, the qualitative analysis revealed favorable experiences and feelings of the FCGs, such as positive emotions, social interactions, and person-centered attitudes to and positive relationships with PwCI.

CONCLUSIONS

This program demonstrated high feasibility with FCGs' favorable responses to emotions and relationships with PwCI, ensuring future investigations with a confirmatory study design.

Research trends in drama therapy: a bibliometric analysis based on Scopus

Aim

As drama therapy has become increasingly important in healthcare, the number of scientific publications has increased, complicating the orientation in the research field. Therefore, the aim of this study is to provide a comprehensive overview of research trends in drama therapy, assessing the impact factors of publications and analyzing the research structure.

Methods

Three hundred and ninety-five scientific articles indexed in Scopus were analyzed without time, geographic and language restrictions using bibliometric analysis methods - performance analysis, citation analysis, and science mapping. Data processing was performed using MS Excel, VOSviewer and Biblioshiny software.

Results

The work of the pioneers of drama therapy continues to be actively cited, influencing the development of drama therapy. Today's leading researchers are increasingly engaging in collaborative research, working across disciplines and contributing to scientific progress. The hot topic of research is older adults and mental health. The diversity of terminology and the large volume of unpublished research point to the need for consolidation. Altmetric analysis would optimize the use of scientific information, promoting innovative research.

Conclusion

This is the first study using the Scopus database to perform an extensive bibliometric analysis of research articles on drama therapy applying Biblioshiny and VOSviewer software. The results of the analysis reflect the evolution of the field from its historical roots to academic maturity, highlighting its current dynamic growth and the trend of drama therapy to establish itself as an interdisciplinary field in the healthcare system. This work serves as a valuable resource for the scientific community, professionals, students, and librarians in the field, helping to optimize the use of scientific resources in drama therapy and contributing to its future development.

A qualitative examination on the implementation of participatory "A"rt-based activity on "Health" of older community-dwellers: what worked for the Singapore A-Health Intervention?

Introduction

Art and museum-based interventions are gaining increasing recognition for their potential as low-risk activities for older adults, offering numerous physical, cognitive, and emotional benefits. However, there remains a dearth of knowledge regarding the science of implementation as well as the factors and processes that contribute to their effectiveness from the perspectives of intervention participants.

Methods

The current research draws on the qualitative evaluation data obtained from a larger mixed-method randomized control trial that evaluated a standardized Participatory "A"rt-Based Activity On "Health" of Older Community-Dwellers-the Singapore A-Health Intervention. Adopting a participatory action research approach, the primary objective is to critically examine the lived experiences and health impact of the Singapore A-Health Intervention with a secondary objective to uncover strategies for optimized implementation outcomes. All 56 participants who completed the intervention filled out a program evaluation survey and a nested sample of 30 participants completed a series of acceptability focus groups.

Results

Descriptive analyses of the program evaluation survey data revealed that 96.2% of participants were satisfied with the overall experience of the Singapore A-Health intervention (M = 9.00, SD = 1.76), reported that the intervention positively impacted their quality of life (M = 8.90, SD = 1.43), and social wellbeing (M = 8.92, SD = 1.43). Thematic analysis with a grounded theory approach on the qualitative focus group data revealed three interrelated themes detailing how the Singapore A-Health Intervention contributed to positive health and wellbeing outcomes (1. A-Health Experience, 2. Wellbeing Outcomes, 3. Enabling Factors) and nine subthemes (1a. Intellectual Stimulation, 1b. Positive Stress, 1c. Peer Interaction, 2a. Interpersonal Bonds, 2b. Personal Growth, 2c. Mindful Living, 3a. Integrated Support, 3b. Session Design, 3c. Mode of Engagement).

Discussion

This investigation provides important insights to the Singapore A-Health intervention's effectiveness for enhancing wellbeing among older adults, as well as the factors that enable successful program implementation. These findings offer a culturally unique perspective on the benefits of art and museum interventions, while underscoring the imperative need for strong partnership and collaborations among community stakeholders in supporting the health and wellbeing of ageing populations.

Art therapy in Alzheimer's disease. An opportunity of collaboration between intersectoral public and private organizations in the co-design of health and social care services

Introduction

The World Health Organization (WHO) has recognized art therapy as an effective supportive mechanism for the maintenance and restoration of mental health. In recent years, art therapy has been integrated in the assistance pathways of older people affected by neurocognitive disorders according to the demonstrated benefits, as no conflicts with pharmacologic treatments and the reduction of anxiety and stress. The shortage of organizational, economic, and professional resources in social-health public organizations does not allow for guaranteeing the provision of these services without the help of the private ones, not exclusively belonging to social-health sector. This research aims to investigate how the collaboration between public and private organizations of different sectors in the co-provision of non-pharmacological approaches guarantees the economic sustainability and the quality improvement of the provided services.

Methods

The Alzheimer Café of Prato was selected as a significant case study.

Results and Discussion

Art therapy programs intended for taking care of older people in the first stages of the Alzheimer's disease have been developed, planned, supplied, and managed over the years as a result of the integration of resources, ideas, and professionals provided both by public and private sectors, the social-health sector, and cultural organizations.

Conclusions

The peer-to-peer co-responsibility of all organizations (public and private, from the cultural sector as well as the social and health sector) involved in the co-design of art therapy programs, not limiting their actions to only co-financing and/or co-delivery of the service, enabled the achievement of the economic sustainability of the services and the improvement of their quality.

Effectiveness of creative story therapy for dementia: a systematic review and meta-analysis

OBJECTIVE

To conduct a meta-analysis of the effectiveness of creative story therapy versus routine nursing alone for the treatment of dementia.

METHODS

We manually searched PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), China VIP Database (VIP), China Biomedical Literature Database (CBM), and Wanfang Data up to May 2023. Randomized controlled trials (RCTs) of creative story therapy combined with routine nursing versus routine nursing for the treatment of dementia were included.

RESULTS

A total of 597 participants were enrolled in the 9 RCTs. Among them, 296 were in the creative story therapy group, and 301 were in the routine nursing group. We found statistically significant effects of creative story therapy combined with routine nursing on cognitive function [standardized mean difference (SMD) = 0.99, 95% CI 0.57, 1.41, P < 0.00001], CSDD score [mean difference (MD) =  - 1.71, 95% CI - 3.27, - 0.14, P < 0.00001], quality of life [SMD = 0.97, 95% CI 0.04, 1.90, P = 0.04], and social communication [MD = 0.46, 95% CI 0.17, 0.74, P < 0.00001] between the creative story therapy group and routine nursing groups; no significant difference in change in basic needs communication [MD = 0.09, 95% CI - 0.58, 0.76, P < 0.00001].

CONCLUSION

This meta-analysis shows that creative story therapy combined with routine nursing has significant effectiveness in improving cognitive function and depression in people with dementia. More high-quality RCTs are required to validate these results.

The role of arts engagement in reducing cognitive decline and improving quality of life in healthy older people: a systematic review

In recent years, arts engagement has been proposed as a non-pharmacological approach to reduce cognitive decline and increase well-being and quality of life in specific populations such as the elderly or patients with severe disease. The aim of this systematic review was to assess the effects of receptive or active arts engagement on reducing cognitive decline and improving quality of life and well-being in healthy populations, with a particular focus on the role of arts engagement in the long term. A comprehensive search strategy was conducted across four databases from February to March 2023. Ten studies with a total of 7,874 participants were incorporated in accordance with the PRISMA guidelines. Active and receptive arts engagement was found to be an effective approach to reduce cognitive decline and improve well-being and quality of life in healthy populations. The role of the positive effects of arts engagement could be determined by the combination of several factors such as exposure to cultural activities and the group effect. There is limited evidence of the protective effects of active arts engagement over a long period of time. Given the increasing demand for preventive programmes to reduce the negative effects of population ageing, more research on arts engagement should be conducted to identify its mechanisms and long-term effects.

Benefits of Cultural Activities on People with Cognitive Impairment: A Meta-Analysis

BACKGROUND

Museums and cultural institutions are increasingly aware of both the interests and needs of society. Accordingly, these institutions are becoming allies in terms of health and well-being due to the importance of their social functions. Presently, many institutions create cultural activities aimed at cognitively impaired people, a group on the rise owing to the prevalence of dementia and the aging of society. Nevertheless, scientific evidence in this field remains scarce. As a result, the main objective of this research was to empirically evaluate and identify the benefits that cultural interventions can bring to cognitively impaired participants.

METHOD

A meta-analysis (MA) was performed following PRISMA guidelines. When inclusion and eligibility criteria had been established, articles were subsequently selected through a strategic search of Web of Science, SCOPUS, PubMed, and Medline.

RESULTS

Twenty-six studies met the eligibility criteria, involving a total of 1201 participants with cognitive impairment. The results showed a statistically non-significant effect size when analyzing these cultural interventions for cognitively impaired people overall. However, when conducting partial meta-analyses (MA'), focusing on studies related to a specific disease, a particular type of treatment, or a specific type of evaluation, the results concurred with the conclusion of the previous systematic review (SR).

CONCLUSION

Despite the high heterogeneity of the studies, benefits were identified in emotional well-being and social aspects but not in clinical ones such as the deterioration of cognitive or motor function, among others.