Perceived stress levels in older adults with financial strain are diminished after theater practice

Izumi Matsudaira; Yasuyuki Taki

doi:10.12688/f1000research.110340.1

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Research Article

Perceived stress levels in older adults with financial strain are diminished after theater practice

[version 1; peer review: 1 approved with reservations]

Izumi Matsudaira ¹, Yasuyuki Taki¹

PUBLISHED 23 May 2022

Author details Author details

¹ Smart-Aging Research Center, Tohoku University, Sendai, Miyagi, 9808575, Japan

Izumi Matsudaira
Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Visualization, Writing – Original Draft Preparation

Yasuyuki Taki
Roles: Funding Acquisition, Project Administration, Supervision, Writing – Original Draft Preparation

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REVIEWER STATUS

Abstract

Background: Participating in theater has been shown to be useful for reducing cognitive decline in older adults. This study focused on the social inclusion aspect of the performing arts and aimed to examine whether participation in the theater could help prevent dementia in older adults who are vulnerable to social exclusion.
Methods: Our participants were 371 community-dwelling older adults who belonged to the Gold Arts Club organized by the Saitama Arts Theatre. The change in perceived stress levels after a month and a half of theater practice were compared between older adults with and without financial strain.
Results: It was revealed that older adults with financial strain had a significantly greater reduction in perceived stress levels than those without financial strain after a month and a half of theater practice.
Conclusions: Since stress is one of the risk factors for cognitive decline, the results of this study suggest that participation in theater may be an effective way of reducing cognitive decline associated with dementia in the older people who feel strained financially.

Keywords

theater, financial strain, perceived stress, dementia, social inclusion

Corresponding author: Izumi Matsudaira

Competing interests: This study received funding from the Saitama Arts Theatre. This funder had a role in the study design and data collection in terms of providing access to the study participants and offering the use of a survey site. However, this funder had no role in the data analysis, preparation of the manuscript, or decision to publish.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2022 Matsudaira I and Taki Y. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Matsudaira I and Taki Y. Perceived stress levels in older adults with financial strain are diminished after theater practice [version 1; peer review: 1 approved with reservations]. F1000Research 2022, 11:563 (https://doi.org/10.12688/f1000research.110340.1) First published: 23 May 2022, 11:563 (https://doi.org/10.12688/f1000research.110340.1) Latest published: 23 May 2022, 11:563 (https://doi.org/10.12688/f1000research.110340.1)

Introduction

Acting involves generating emotions and behaviors to characterize a person or thing other than themselves. Higher cognitive functions, such as emotion regulation, memory, verbal skills, empathy, and mentalization, are necessary skills for acting (McDonald et al., 2020). It has been suggested that participation in theater may improve cognitive function in older adults (Banducci et al., 2017; Chung et al., 2018; Noice et al., 2004). In the recent field of preventive medicine, personalized prevention has gained support as an effective strategy for preventing dementia (Sommerlad & Mukadam, 2020). Thus, it is meaningful to detect the population that participating in theater is a more valid choice to maintain cognitive health.

Social inclusion may be the key concept linking the theater with personalized prevention of dementia. Social inclusion is defined as the process of ensuring that people at risk of being left behind in society have the opportunities and resources they need to participate fully in economic, social, political, and cultural life, and to enjoy a level of well-being that is considered normal in the society in which they live (European Commision, 2004). The World Bank Group has argued the importance of performing arts for the maturation of society in terms of their social inclusion function (Kabanda, 2014). Older adults are likely to be targets of social exclusion (Walsh et al., 2017). Community-engaged art programs for older adults have been reported to promote well-being (Phinney et al., 2014; Poulos et al., 2019) and a sense of connectedness with the community (Moody & Phinney, 2012). However, the effect that participating in the arts has on older people, particularly those at high risk of social exclusion, is unclear.

One of the significant risk factors for social exclusion is financial strain, which refers to the perception that paying for both daily necessities (e.g., food, clothing, housing, and medical care) and other things, such as furniture, automobiles, and recreation (Pearlin et al., 1981), is difficult. A validation study of the social exclusion index for older adults found a significant positive association between self-perceived poverty and a sense of social exclusion (Chou, 2018). Recent findings have also suggested that financial strain increases the risk of developing dementia (Samuel et al., 2020). A putative mechanism underlying the relationship between financial strain and dementia may be an impairment in the stress response system because a significant association between financial strain and physiological markers of stress has been reported (Grossi et al., 2001; Palta et al., 2015; Steptoe et al., 2020). Also, it has been confirmed that psychological stress is associated with the increased risk of dementia (Franks et al., 2021).

This study, therefore, aimed to determine whether participating in the theater could be an effective way of preventing dementia in older adults with financial strain. To achieve this goal, we adopted a cohort design to investigate the effect of participating in the theater on perceived stress levels in older adults according to the presence or absence of financial strain.

Methods

Participants

Our participants were community-dwelling older adults who belonged to the Gold Arts Club organized by the Saitama Arts Theatre (https://www.saf.or.jp/arthall/). The Gold Arts Club is a large theatre company with almost 1,600 members and features large crowd plays with hundreds of performers. Members of the Gold Arts Club were recruited in 2016 through an open call for applications, provided that they were ≥ 60 years old at the time. The members include both experienced and inexperienced theatre performers, but no professional actors. The Gold Arts Club performed one play each year between 2016 and 2018 after a month or two of rehearsals. Each member had participated in at least one performance at the time of this study. Our survey was distributed in November 2019, when the Gold Arts Club was preparing for its fourth performance. The eligibility criteria was males and females aged 65 over, because in Japan, the definition of an elderly is being 65 years and older (Cabinet Office Japan, 2018). The pre-survey was carried out on the day of orientation before the start of rehearsals, and the post-survey was carried out during the final rehearsal about a month and a half later. Participants took part in up to six rehearsals of approximately two and a half hours each between the pre-and post-surveys. A total of 786 people participated in this production, of which 639 took part in the pre-survey. Of these, 456 also completed the post-survey. After excluding 62 participants with missing answers and 23 participants who were under 64 years, 371 participants were included in the final analysis. The purpose of this study was explained to the participants during the pre-survey. Written informed consent was obtained from each participant. This study was approved by the Institutional Review Board of Tohoku University.

Financial strain

Participants chose one of the following options to describe their financial situation: 1 = difficult, 2 = slightly difficult, 3 = somewhat secure, and 4 = secure. Those who chose 1 or 2 were categorized into the group with financial strain, while those who chose 3 or 4 were categorized into the group without financial strain. This question was asked only during the pre-survey.

Perceived stress levels

The perceived stress levels were assessed using the Comprehensive Stress Response Inventory for the elderly (http://labo-wakashima.c.ooco.jp/CSI_elder.pdf), a scale that assesses stress levels through the extent of psychological stress response experienced in the preceding month (Asai et al., 2013). The answers to the 17 questions were summed to calculate a perceived stress score. A Likert scale ranging from 1 to 4 (1 = “never” to 4 = “very often”) was used. These questions were asked both in the pre-and post-surveys. We subtracted the pre-survey score from the post-survey score to measure the change in perceived stress levels before and after participating in the theater practice.

Statistical analysis

Mann-Whitney’s U test was conducted to compare the extent of the change in perceived stress levels between the groups with and without financial strain. The significance level was set at P < 0.05. This analysis was performed using R studio (Version 1.2.5042).

Results

The participants’ characteristics are presented in Table 1. No significant differences in age, sex, the number of previous performances, and the perceived stress levels at the post-survey were found between the groups. The perceived stress levels on the pre-survey were significantly higher in those with financial strain than in those without financial strain (Table 1).

Table 1. Participants’ characteristics.

	Total (N = 394)			With financial strain (N = 60)			Without financial strain (N = 334)			Statistics
	Min	Median	Max	Min	Median	Max	Min	Median	Max	W	P-value
Age (years)	65	70	88	65	71	85	65	70	88	9843.0	0.2280
Number of productions^a	1	3	3	2	3	3	1	3	3	8669.0	0. 5586
Stress_pre^b	17	20	46	17	23	40	17	20	46	11702.0	0.0001
Stress_post^c	17	20	54	17	21	40	17	20	54	9939.0	0.1794

	Male	Female		Male	Female		Male	Female		χ²	P-value
Sex	85	286		10	47		75	239		1.0984	0.2946

a The number of productions at the Gold Arts Club the participant had participated in before the survey.

b Score of perceived stress levels at the pre-survey.

c Score of perceived stress levels at the post-survey. As all continuous variables in this data did not distribute normally, the differences between groups were analyzed using Mann-Whitney’s U test.

As shown in Figure 1 and Table 2, participants with financial strain showed a significantly greater decrease in perceived stress levels after participating in the theater practice than those without financial strain.

Figure 1. Group difference in the changes in perceived stress levels before and after theater practice.

With_pre, score at the pre-survey in older adults with financial strain. With_post, score at the post-survey in older adults with financial strain. Without_pre, score at the pre-survey in older adults without financial strain. Without_post, score at the post-survey in older adults without financial strain.

Table 2. Group differences in the changes in perceived stress levels.

	With financial strain			Without financial strain			Statistics
	Min	Median	Max	Min	Median	Max	W	r	P-value
StressΔ^a	−16	−1	8	−25	0	32	7254.0	0.1188	0.0221

a Subtracted value of perceived stress levels at the pre-survey from the post-survey.

Discussion

Our results are consistent with the idea that economically disadvantaged older adults are likely to experience depressive symptoms (Mojtabai & Olfson, 2004). The findings of neuroimaging studies may explain why the perceived stress levels declined before and after theatre practice. Recent pioneering work about neural substrates of acting revealed that when actors respond to several questions as fictional characters, the ventromedial prefrontal cortex (vmPFC) is deactivated compared to when they responded as themselves (Brown et al., 2019). The vmPFC activation has been associated with stress resilience and recovery (Sinha et al., 2016; Meine et al., 2021; Yang et al., 2018). Consequently, although the subjects of these previous neuroimaging studies were younger than our participants, it is speculated that the reduction in perceived stress levels may have been due to the flexibility of vmPFC activation through repeated experiences of leaving from one’s own perspective through theater practice.

This study has limitations. First, due to that we have no control group, it should be noted that this study is preliminary to examine the effect of theatre participation on the reduction in perceived stress levels among economically disadvantaged older people. Further study designed with the randomized controlled trial is necessary. Second, the participants in this study were not complete beginners in theater. This may have reduced the impact of theater practice on their perceived stress levels in this study. Third, since this study only involved participants in theater practice, it is not possible to make any definite claims about whether the present results are specific to the theater. Further studies designed to compare theater and other artistic activities are needed.

To the best of our knowledge, this is the first study to reveal that participating in the theater improves mental health particularly in older people with financial strain. Since higher psychological stress increases the risk of dementia, participation in theater may be an effective way to prevent dementia in older adults who are experiencing financial difficulties.

Consent

Written informed consent for publication of their answers for questionnaire was obtained from the participants.

Data availability

Figshare. Perceived_stress_levels_in_older_adults _with_financial_strain_are_diminished_after _theater_practice.xlsx. DOI: https://doi.org/10.6084/m9.figshare.19657143.v3

This project contains the following underlying data:

- Our participants were community-dwelling older adults who belonged to the Gold Arts Club organized by the Saitama Arts Theatre (https://www.saf.or.jp/arthall/). The Gold Arts Club performed one play each year between 2016 and 2018 after a month or two of rehearsals. Each member had participated in at least one performance at the time of this study.
- Financial Strain: Participants chose one of the following options to describe their financial situation: 1 = difficult, 2 = slightly difficult, 3 = somewhat secure, and 4 = secure. Those who chose 1 or 2 were categorized into the group with financial strain, while those who chose 3 or 4 were categorized into the group without financial strain. This question was asked only during the pre-survey.
- Stress Levels: The stress levels were assessed using the Comprehensive Stress Response Inventory for the elderly (http://labo-wakashima.c.ooco.jp/CSI_elder.pdf), a scale that assesses stress levels through the extent of psychological stress response experienced in the preceding month. The answers to the 17 questions were summed to calculate a perceived stress score. A Likert scale ranging from 1 to 4 (1 = “never” to 4 = “very often”) was used. These questions were asked both in the pre-and post-surveys. We subtracted the pre-survey score from the post-survey score to measure the change in stress levels before and after participating in the theater practice.

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Acknowledgement

We appreciate Mr. Hiroshi Watanabe, Mr. Fumiaki Taniguchi, Ms. Sachiko Ukegawa, Mr. Tatsuya Takagi, and Ms. Takako Maeda for collaborating with us as research partners. We also thank all the members of the Saitama Gold Arts Club, the Saitama Gold Theatre, and the Saitama Arts Theatre. We thank Editage (www.editage.com) for English language editing.

References

Asai K, Morikawa N, Hiraizumi T, et al.: Development of Comprehensive Stress Response Inventory. Annual Report Graduate School of Education, Tohoku University; 2013; 62(1): 283–302.
Banducci SE, Daugherty AM, Biggan JR, et al.: Active Experiencing Training Improves Episodic Memory Recall in Older Adults. Front. Aging Neurosci. 2017; 9: 133. Publisher Full Text
Brown S, Cockett P, Yuan Y: The neuroscience of Romeo and Juliet: an fMRI study of acting. R. Soc. Open Sci. 2019; 6(3): 181908. PubMed Abstract | Publisher Full Text
Cabinet Office Japan: Annual Report on the Ageing Society. Tokyo: Cabinet Office Japan; 2018.
Chou K-L: Social exclusion in old age: a validation study in Hong Kong. Aging Ment. Health. 2018; 22(8): 1078–1085. PubMed Abstract | Publisher Full Text
Chung KSY, Lee ESL, Tan JQ, et al.: Effects of Playback Theatre on cognitive function and quality of life in older adults in Singapore: A preliminary study. Australas. J. Ageing. 2018; 37(1): E33–E36. PubMed Abstract | Publisher Full Text
European Commision: Joint Report on Social Inclusion (Report 7101/04). Brussels: European Commission; 2004.
Franks KH, Bransby L, Saling MM, et al.: Association of Stress with Risk of Dementia and Mild Cognitive Impairment: A Systematic Review and Meta-Analysis. J. Alzheimers Dis. 2021; 82(4): 1573–1590. PubMed Abstract | Publisher Full Text
Grossi G, Perski A, Lundberg U, et al.: Associations between financial strain and the diurnal salivary cortisol secretion of long-term unemployed individuals. Integrative Physiological and Behavioral Science: The Official Journal of the Pavlovian Society. 2001; 36(3): 205–219. PubMed Abstract | Publisher Full Text
Kabanda P: The creative wealth of nations: How the performing arts can advance development and human progress. The World Bank; 2014. Publisher Full Text
McDonald B, Goldstein TR, Kanske P: Could Acting Training Improve Social Cognition and Emotional Control?. Front. Hum. Neurosci. 2020; 14: 348. PubMed Abstract | Publisher Full Text
Meine LE, Meier J, Meyer B, et al.: Don’t stress, it's under control: Neural correlates of stressor controllability in humans. NeuroImage. 2021; 245: 118701. PubMed Abstract | Publisher Full Text
Mojtabai R, Olfson M: Major depression in community-dwelling middle-aged and older adults: prevalence and 2- and 4-year follow-up symptoms. Psychol. Med. 2004; 34(4): 623–634. PubMed Abstract | Publisher Full Text
Moody E, Phinney A: A community-engaged art program for older people: fostering social inclusion. Can. J. Aging (La Revue Canadienne Du Vieillissement). 2012; 31(1): 55–64. PubMed Abstract | Publisher Full Text
Noice H, Noice T, Staines G: A short-term intervention to enhance cognitive and affective functioning in older adults. J. Aging Health. 2004; 16(4): 562–585. PubMed Abstract | Publisher Full Text
Palta P, Szanton SL, Semba RD, et al.: Financial strain is associated with increased oxidative stress levels: the Women’s Health and Aging Studies. Geriatr. Nurs. 2015; 36(2 Suppl): S33–S37. PubMed Abstract | Publisher Full Text
Pearlin LI, Lieberman MA, Menaghan EG, et al.: The stress process. J. Health Soc. Behav. 1981; 22(4): 337–356. Publisher Full Text Reference Source
Phinney A, Moody EM, Small JA: The Effect of a Community-Engaged Arts Program on Older Adults’ Well-being. Can. J. Aging (La Revue Canadienne Du Vieillissement). 2014; 33(3): 336–345. Publisher Full Text
Poulos RG, Marwood S, Harkin D, et al.: Arts on prescription for community-dwelling older people with a range of health and wellness needs. Health Soc. Care Community. 2019; 27(2): 483–492. Publisher Full Text
Samuel LJ, Szanton SL, Wolff JL, et al.: Socioeconomic disparities in six-year incident dementia in a nationally representative cohort of U.S. older adults: an examination of financial resources. BMC Geriatr. 2020; 20(1): 156. PubMed Abstract | Publisher Full Text
Sinha R, Lacadie CM, Constable RT, et al.: Dynamic neural activity during stress signals resilient coping. Proc. Natl. Acad. Sci. U. S. A. 2016; 113(31): 8837–8842. Publisher Full Text
Sommerlad A, Mukadam N: Evaluating risk of dementia in older people: a pathway to personalized prevention?. Eur. Heart J. 2020; 41(41): 4034–4036. Publisher Full Text
Steptoe A, Emch S, Hamer M: Associations Between Financial Strain and Emotional Well-Being With Physiological Responses to Acute Mental Stress. Psychosom. Med. 2020; 82(9): 830–837. Publisher Full Text
Walsh K, Scharf T, Keating N: Social exclusion of older persons: a scoping review and conceptual framework. Eur. J. Ageing. 2017; 14(1): 81–98. PubMed Abstract | Publisher Full Text
Yang X, Garcia KM, Jung Y, et al.: vmPFC activation during a stressor predicts positive emotions during stress recovery. Soc. Cogn. Affect. Neurosci. 2018; 13(3): 256–268. Publisher Full Text

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Author details Author details

¹ Smart-Aging Research Center, Tohoku University, Sendai, Miyagi, 9808575, Japan

Izumi Matsudaira
Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Visualization, Writing – Original Draft Preparation

Yasuyuki Taki
Roles: Funding Acquisition, Project Administration, Supervision, Writing – Original Draft Preparation

Competing interests

This study received funding from the Saitama Arts Theatre. This funder had a role in the study design and data collection in terms of providing access to the study participants and offering the use of a survey site. However, this funder had no role in the data analysis, preparation of the manuscript, or decision to publish.

Grant information

The author(s) declared that no grants were involved in supporting this work.

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Published: 23 May 2022, 11:563

https://doi.org/10.12688/f1000research.110340.1

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© 2022 Matsudaira I and Taki Y. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Matsudaira I and Taki Y. Perceived stress levels in older adults with financial strain are diminished after theater practice [version 1; peer review: 1 approved with reservations]. F1000Research 2022, 11:563 (https://doi.org/10.12688/f1000research.110340.1)

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Reviewer Report 10 Oct 2024

Vaitsa Giannouli, Department of Psychology, University of Western Macedonia & School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece

Approved with Reservations

https://doi.org/10.5256/f1000research.121935.r225856

This article investigates if theater can be used as an intervention for older adults who are vulnerable to social exclusion. Some points to revise can be found below:

In the Abstract, please provide basic statistics in

This article investigates if theater can be used as an intervention for older adults who are vulnerable to social exclusion. Some points to revise can be found below:

In the Abstract, please provide basic statistics in the Results section.
In the Introduction authors need to support their hypotheses with relevant literature.
Please justify the over 60 years of age as an inclusion critierion. Usually over 65 is used in most published studies.
How was the sample size estimated?
Please explain the figures in the main text.
Please provide a more detailed discussion.

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

Partly
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Partly
Are the conclusions drawn adequately supported by the results?

Partly

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Psychology

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Vaitsa Giannouli, Department of Psychology, University of Western Macedonia & School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece

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Approved With Reservations

This article investigates if theater can be used as an intervention for older adults who are vulnerable to social exclusion. Some points to revise can be found below:

In the Abstract, please provide basic statistics in the Results section.
In the Introduction authors need to support their hypotheses with relevant literature.
Please justify the over 60 years of age as an inclusion critierion. Usually over 65 is used in most published studies.
How was the sample size estimated?
Please explain the figures in the main text.
Please provide a more detailed discussion.

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

Partly
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Partly
Are the conclusions drawn adequately supported by the results?

Partly

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Psychology

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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[1] Asai K, Morikawa N, Hiraizumi T, et al.: Development of Comprehensive Stress Response Inventory. Annual Report Graduate School of Education, Tohoku University; 2013; 62(1): 283–302.

[2] Banducci SE, Daugherty AM, Biggan JR, et al.: Active Experiencing Training Improves Episodic Memory Recall in Older Adults. Front. Aging Neurosci. 2017; 9: 133. Publisher Full Text

[3] Brown S, Cockett P, Yuan Y: The neuroscience of Romeo and Juliet: an fMRI study of acting. R. Soc. Open Sci. 2019; 6(3): 181908. PubMed Abstract | Publisher Full Text

[4] Cabinet Office Japan: Annual Report on the Ageing Society. Tokyo: Cabinet Office Japan; 2018.

[5] Chou K-L: Social exclusion in old age: a validation study in Hong Kong. Aging Ment. Health. 2018; 22(8): 1078–1085. PubMed Abstract | Publisher Full Text

[6] Chung KSY, Lee ESL, Tan JQ, et al.: Effects of Playback Theatre on cognitive function and quality of life in older adults in Singapore: A preliminary study. Australas. J. Ageing. 2018; 37(1): E33–E36. PubMed Abstract | Publisher Full Text

[7] European Commision: Joint Report on Social Inclusion (Report 7101/04). Brussels: European Commission; 2004.

[8] Franks KH, Bransby L, Saling MM, et al.: Association of Stress with Risk of Dementia and Mild Cognitive Impairment: A Systematic Review and Meta-Analysis. J. Alzheimers Dis. 2021; 82(4): 1573–1590. PubMed Abstract | Publisher Full Text

[9] Grossi G, Perski A, Lundberg U, et al.: Associations between financial strain and the diurnal salivary cortisol secretion of long-term unemployed individuals. Integrative Physiological and Behavioral Science: The Official Journal of the Pavlovian Society. 2001; 36(3): 205–219. PubMed Abstract | Publisher Full Text

[10] Kabanda P: The creative wealth of nations: How the performing arts can advance development and human progress. The World Bank; 2014. Publisher Full Text

[11] McDonald B, Goldstein TR, Kanske P: Could Acting Training Improve Social Cognition and Emotional Control?. Front. Hum. Neurosci. 2020; 14: 348. PubMed Abstract | Publisher Full Text

[12] Meine LE, Meier J, Meyer B, et al.: Don’t stress, it's under control: Neural correlates of stressor controllability in humans. NeuroImage. 2021; 245: 118701. PubMed Abstract | Publisher Full Text

[13] Mojtabai R, Olfson M: Major depression in community-dwelling middle-aged and older adults: prevalence and 2- and 4-year follow-up symptoms. Psychol. Med. 2004; 34(4): 623–634. PubMed Abstract | Publisher Full Text

[14] Moody E, Phinney A: A community-engaged art program for older people: fostering social inclusion. Can. J. Aging (La Revue Canadienne Du Vieillissement). 2012; 31(1): 55–64. PubMed Abstract | Publisher Full Text

[15] Noice H, Noice T, Staines G: A short-term intervention to enhance cognitive and affective functioning in older adults. J. Aging Health. 2004; 16(4): 562–585. PubMed Abstract | Publisher Full Text

[16] Palta P, Szanton SL, Semba RD, et al.: Financial strain is associated with increased oxidative stress levels: the Women’s Health and Aging Studies. Geriatr. Nurs. 2015; 36(2 Suppl): S33–S37. PubMed Abstract | Publisher Full Text

[17] Pearlin LI, Lieberman MA, Menaghan EG, et al.: The stress process. J. Health Soc. Behav. 1981; 22(4): 337–356. Publisher Full Text Reference Source

[18] Phinney A, Moody EM, Small JA: The Effect of a Community-Engaged Arts Program on Older Adults’ Well-being. Can. J. Aging (La Revue Canadienne Du Vieillissement). 2014; 33(3): 336–345. Publisher Full Text

[19] Poulos RG, Marwood S, Harkin D, et al.: Arts on prescription for community-dwelling older people with a range of health and wellness needs. Health Soc. Care Community. 2019; 27(2): 483–492. Publisher Full Text

[20] Samuel LJ, Szanton SL, Wolff JL, et al.: Socioeconomic disparities in six-year incident dementia in a nationally representative cohort of U.S. older adults: an examination of financial resources. BMC Geriatr. 2020; 20(1): 156. PubMed Abstract | Publisher Full Text

[21] Sinha R, Lacadie CM, Constable RT, et al.: Dynamic neural activity during stress signals resilient coping. Proc. Natl. Acad. Sci. U. S. A. 2016; 113(31): 8837–8842. Publisher Full Text

[22] Sommerlad A, Mukadam N: Evaluating risk of dementia in older people: a pathway to personalized prevention?. Eur. Heart J. 2020; 41(41): 4034–4036. Publisher Full Text

[23] Steptoe A, Emch S, Hamer M: Associations Between Financial Strain and Emotional Well-Being With Physiological Responses to Acute Mental Stress. Psychosom. Med. 2020; 82(9): 830–837. Publisher Full Text

[24] Walsh K, Scharf T, Keating N: Social exclusion of older persons: a scoping review and conceptual framework. Eur. J. Ageing. 2017; 14(1): 81–98. PubMed Abstract | Publisher Full Text

[25] Yang X, Garcia KM, Jung Y, et al.: vmPFC activation during a stressor predicts positive emotions during stress recovery. Soc. Cogn. Affect. Neurosci. 2018; 13(3): 256–268. Publisher Full Text

Perceived stress levels in older adults with financial strain are diminished after theater practice

Abstract

Keywords

Introduction

Methods

Participants

Financial strain

Perceived stress levels

Statistical analysis

Results

Table 1. Participants’ characteristics.

Figure 1. Group difference in the changes in perceived stress levels before and after theater practice.

Table 2. Group differences in the changes in perceived stress levels.

Discussion

Consent

Data availability

Acknowledgement

References

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