Visual art therapy as a treatment option for cognitive decline among older adults. A systematic review and meta-analysis.

AIMS: To investigate the effects of visual art therapy on cognitive and psychological outcomes and explore the crucial design characteristics of visual art therapy that might be associated with greater cognitive benefits among older adults. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Peer reviewed articles were searched from Medline, EMBASE, Global Health, Cochrane Library, Ovid Nursing database, PsycINFO, British Nursing Index and CINAHL Complete from inception of the databases to September 2019. REVIEW METHODS: This review and meta-analysis was conducted and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Cochrane risk of bias tool was used to examine the risk of bias of the studies. Narrative synthesis and quantitative meta-analysis were performed. RESULT: Twelve articles published between 2004 - 2019 involving 831 participants were identified. Visual art therapy significantly improved global cognitive function compared with different control groups (Hedges' g = 0.348 (95%CI = 0.026-0.671), p = .034, I2  = 66.570%). Visual art therapy also demonstrated psychological benefits in reducing depressive symptoms and anxiety. By systematic comparison of the intervention designs, it seems that those with greater cognitive benefit involved a higher level of creativity and optimized the use of essential components including art-education, reminiscence, art-processing, cognitive evaluation, art-crafts/modelling and socialization. CONCLUSION: Visual art therapy could be effective in improving cognitive functions and the associated psychological symptoms. Therefore, it can be adopted as an effective non-pharmacological intervention for preventing cognitive decline and dementia. IMPACT: This review answers the key question regarding the pooled effect of visual art therapy as non-pharmacological therapy on preventing or managing dementia. In addition, it informs on the design characteristics of an effective visual art therapy for implementing among older adults. This research will have an impact on the gerontological care and support the evidence regarding non-pharmacological approaches to prevent and manage dementia.