In what context and by which mechanisms can creative arts interventions improve wellbeing in older people? A realist review from UK community settings

AIMS: To develop a theoretical understanding of the contexts and mechanisms through which creative arts interventions can improve wellbeing in community-dwelling UK adults aged 65 and over, and to provide practical recommendations for future research and intervention design. METHOD: We conducted a realist literature review consistent with RAMESES standards. We developed a programme theory explaining how participation in creative arts impacts wellbeing in older adults by carrying out a systematic search of bibliographic databases (MEDLINE, EMBASE, PsycINFO, CINAHL, and Web of Science Core Collection) and through regular engagement with a stakeholder group. Relevant sections of text relating to the programme theory were extracted and synthesised using realist logic to identify context-mechanism-outcome configurations (CMOCs). RESULTS: Nine articles were included, comprising peer-reviewed articles (seven) and grey literature (two). Most programmes took place in England (89%). Multiple activities were offered, including painting, dancing, and craftwork. Thirty-two CMOCs were identified. Impact on wellbeing was greatest when interventions enabled sustained attendance, opportunities to socialise without obligation, skilled facilitation, emotionally resonant artistic themes, and experiences that foster psychological flow. Barriers to participation included logistical challenges, fears of being patronised or stereotyped, and perceptions of the arts as exclusive or requiring prior skill. CONCLUSION: The programme theory developed relates to concepts of autonomy, individualism, and emotional, social, and eudaimonic wellbeing. Based on this theory, we present a series of practical recommendations to guide future research and intervention design. To maximise impact, creative arts programmes should adopt nuanced, co-produced approaches supported by sustainable funding.