Episode: Museum Learning to Mitigate Loneliness Among Elders
Guest: Lucas Livingston, MA
Host: Tim Hoff
Transcript by: Lucas Livingston, MA
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TIM HOFF (Host): Welcome to another special edition of Ethics Talk the American Medical Association Journal of ethics podcast on ethics in health and health care. I'm your host, Tim Hoff.
Well before COVID-19 began spreading, the US was going through another public health crisis: loneliness. The effects of loneliness and isolation can be grave. Poor social relationships were associated with a 29% increase in the risk of coronary heart disease and a 32% rise in the risk of stroke. The loneliness epidemic affects elders in particular with 27% of older adults living alone. The causes are many — marginalization in a youth-oriented society, lack of access and accommodations for those with limited physical mobility — and they have been exacerbated in recent months with sheltering in place during the pandemic. Collaborations between health care organizations and art institutions have been helping people realize the physical and mental health benefits of arts engagement. This has been critical for many as museums remain closed and we remain disconnected from our usual forms of cultural engagement.
Our guest, Lucas Livingston, joined us to talk about roles museums play in helping elders and all of us continue to grow. Formerly with the Art Institute of Chicago, Lucas is an 18-year museum professional focusing on the intersections of arts, aging, health, and accessibility. Lucas, thank you for being here.
LUCAS LIVINGSTON: Thanks so much, Tim. It's a pleasure to be invited.
HOFF: In a recent blog post for the American Society on Aging you mentioned that there is a growing collaboration between museums and the health care sector. Can you tell us a little bit about these collaborations and what they suggest about the importance of art in motivating health, especially for elders?
LIVINGSTON: Yeah for sure, I mean, that's a huge growing field of collaboration between museums and health care and there are a myriad of different ways that many museums are participating with hospitals, with clinics, with schools, medical schools. I can touch on a few. I mean, there's really some low-hanging fruit that some museums are doing. I mean, that's just the environment of, of health facilities, of hospitals and clinics, and I mean there's mounting evidence that demonstrates, if not causation, at least a correlation between simply looking at art and just an overall health — physical and cognitive, mental, emotional, spiritual health — and working in a good way. Looking at art doesn't make you sick, no, but ... So, I mean, some of this low-hanging fruit even is collaborations where art museums are decorating health sectors not with original works of art necessarily but at least reproductions, high quality reproductions. So, sprucing up the place with beautiful pictures, right? Pictures that would engage. So, pictures that just reduce this sort of clinical, sterile environment. But then also much more fruitful direct collaborations and sometimes it's with patients but then also even with the practitioners. With healthcare professionals. Like working with schools of nursing and medicine. So, training healthcare professionals and encouraging them to confront our own internal biases. You know, sharpen their diagnostic skills through looking at art together and even, you know, even addressing their own mental health. Working in the medical field is these extremely high stress, high stakes, high burnout, and oftentimes even under-compensated positions. So, it doesn't always have to be this rigorous like "how can this in turn benefit the patient," but also just benefiting the frontline worker is critically important.
But then working with, yeah, benefiting the patients. So, many other museums across the country, you know, we're collaborating with different medical centers, with Northwestern University, Rush, University of Chicago, to provide therapeutic arts enrichment programs for older adult audiences specifically people diagnosed with Alzheimer's disease and other forms of dementia as well as their care partners too. So, through participation with also professional art therapists to produce these workshops and activities that promote cognitive health and cognitive stimulation through conversations about the art. And it's not about, like, learning art history. If you might accidentally learn something, that's great, but it's really just yeah leveraging artwork more as a, a tool for communication and socialization and breaking down that clinical hierarchy between the care provider and the care recipient. So, and it's often helpful then. Coming to a museum is a neutral space, a stimulating space, breaking out of that the typical day in day out norm. I mean as much as people with Alzheimer's and other forms of dementia might thrive on routine, the result, so, the added benefit of coming to a very stimulating space.
But you know and even on an interesting side note, so I was even reached out to by a fellow from Northwestern University Medical Center who is working on diabetes wondering if looking at images of art could incentivize people with diabetes to receive their annual eye exams. To increase their interest in wanting to participate in annual eye exam screening for visual impairments. And so, I don't know, just the idea of incentivization through looking at images of wonderful works of art.
HOFF: Yeah that's really interesting. Do you know if that work that this researcher is doing has been done or is that ongoing currently?
LIVINGSTON: You know it's been a while since, since she and I have spoken and I don't know what impact the pandemic has had on her work but it's definitely something I'm hoping to follow up on and see where that goes.
HOFF: So what are some of the ... you mentioned that oftentimes it's beneficial to actually, you know, get into the museum and look at these pieces of art in their context and have sort of a stimulating experience, but what are some of the barriers that elders might face when they're trying to engage in art in museums or other public venues?
LIVINGSTON: Yeah sure, sure. Absolutely! I mean that that's, that's definitely something that daily I think about and, and there are many ways to try to overcome some of the barriers but sometimes one of the easiest way to, well it's not easy, but one of the best ways and most effective ways to overcoming a barriers is try not to bring them to the museum, but to go out to them. So, elders and others face a multitude of barriers. You know, even just financial oftentimes, whether it's the cost of admission or the cost of getting to the museum. And so, transportation as well. I know, I mean, like in Chicago, it can, it could take two hours just to go a few miles to get from one side of the city to the museum downtown and the Art Institute is even relatively very much at the central hub of all of the public transit, but still. And so, I mean, there's quite a time commitment. If it's not just like a quick pop over to your local community center or place of worship it's I mean it's it takes the better part of a day or half a day to get there, engage, and then come back. So, I mean, certainly, physical accessibility of a space. That, I mean ... ADA requirements, I mean, to be ADA accessible that's just the bare minimum that a place can and should and must achieve, but it's really just going above and beyond to ensure that equitable level of access. So, whether it's just just trying to traverse the unknown... I think so often people who have limited mobility, they want to... They don't want to come to a place not knowing where's the best way to get in, where are the ramps, will the doors have push plates to open, and so on and so forth. And so, museums can take measures to clearly articulate online how visitors with limited mobility can access the space. Where's the accessible parking? From that point through to "how do I get to a particular auditorium" or such. And so, much as, like, a lot of museums like to create social narratives and put those on their website for families who have children or even grown-ups who are on the autism spectrum, and just to prepare them for that visit. Likewise, we can have these social narratives for physical accessibility.
HOFF: Can you talk a little bit more about what those “social narratives” are for people who are unfamiliar?
LIVINGSTON: Oh, sure yeah I mean, it's very much like a plan, like a step by step type of plan, saying... So, for on the autism spectrum, social narratives often might say "Ok we're going to visit this place. We're going to enter through a front door. There might be a security officer who is going to greet us. We can say hello if we want but we don't have to." So, this step by step thing, you know. "We're gonna put our coats and give them to a nice person who is going to check our coats for us.” And so likewise creating this platform so that people who want to research and know in advance can anticipate how they're going to traverse these barriers.
So and one thing for example at the Art Institute of Chicago on the website you go to the accessibility page and you'll find that not only does it have the basic information about accessible parking and entrances and wheelchair availability and so on and so forth, but also we have, at the moment at least, there's a link to a Google Street View. You know Google Street View is a great way you can see what the entrances look like before you get there. But then also a wonderful thing that happened back, I think it was 2012. As with many other museums around the world Google — Google Arts and Culture Project — you can actually crawl through the galleries of hundreds of museums online and so as though you are going through, well it's like Street View, the same technology, but walking or rolling through the galleries. And so, giving you that sense of what it's going to look like inside the space. It can be very helpful before you arrive there.
You know other barriers I think of also are — whether it's through lifelong blindness or limited vision or hearing loss and deafness or if it's acquired in older age ... so the idea of certainly, especially if it's acquired later in life — how can we ensure that someone who has participated and engaged with the museum or any cultural space, how can … how do they not "age out" quote unquote, so to speak, age out of participation through an acquired disability later in life. So, ensuring that we take measures to make the museum experience as accessible as possible … with limited vision or with limited hearing as well.
So through certain different interventions and such, but, invariably, I always get up on my soapbox and I love to say that any resource that we might provide or any accommodation that we might make for what we conceive of as perhaps being a fairly small segment of the population invariably has far-reaching broader benefit for the population at large. So, one thing you can Google is the "curb cut effect." You know like sidewalks have these curb cuts. There was a time when sidewalks didn't have curb cuts and so when curb cuts were invented through a somewhat revolutionary act of resistance, then all of a sudden surveys were done and they found that so many individuals were taking advantage of the curb cuts. It wasn't anticipated. So, I mean whether if it's a delivery person pushing something or if it's a person pushing a stroller. So, it's not just for wheelchair users. It's likewise with really any resource or accommodation.
HOFF: It sounds like museums are taking a number of steps to make their collections more accessible in person for people who come to the museums and you know see the collections there, but obviously in the world we're living in going to museums is out of the question for many, many places. So what are museums trying to do to make their collections more accessible in the sense of getting their on-site materials, art programs, whatever, to people, who are sheltering in place, who are unable to travel? Things like that.
LIVINGSTON: Yeah, absolutely, I mean, we've seen this explosion of online content development and it takes many forms. A while ago I was even reading an article just talking about ... well one ... this sounds like a relatively simple measure, but it makes or breaks an experience for some people, but how there's this rapid response by museums to generate alt-text for images — images on the website. Art museums, especially, are these highly visual spaces and yeah, of course, rapid digitization of our collection and putting that online so you can browse the whole museum visually through a web browser. But for someone who cannot see the images there's a reliance on alt-text. The short snippet sentence — one or two sentence descriptions or even less than that — fragment of basically just a quick snapshot summary of what is represented in this image, in this photo, in this picture. And so, rapid development of alt-text will help make visual collections accessible remotely for people, who rely on screen readers to tell them what's on the webpage.
But then also putting gallery labels online and ... something a lot of museums have already been doing, but just to increase that at this point, ensuring. But, you know, if you're gonna do that, again, you want to ensure that it is accessible to screen-reading software or any other built-in accessibility features that are in computers, web browsers, smartphones, etc. And then widespread sharing of stories about the collection. You know, whether it's written, like a blog. There's been rapid development of blogs and articles written about the artworks and collection from a variety of perspectives: from curators, conservators, educators, others, even frontline personnel, who engage directly with the visitors day in day out. Or development of audio content like podcasts or such. And video content, like virtual tours, is something a lot of people are talking about. Virtual tours. I mean, you know, often something ... I'm often very jealous of a lot of smaller and more mid-sized museums, because I often see there's a real nimbleness that smaller organizations might enjoy and they can more rapidly scramble to put together this live and recorded content. But large organizations, I mean, they may enjoy profound resources, but it often takes a little bit more time to pull everything together. You know, but, yeah, absolutely then ... as much as we might put content online, there certainly are those who really can't access that. You know, the digital divide, right?
HOFF: Yeah, I was just going to ask about that.
LIVINGSTON: I've been thinking a lot about that, especially the past few months. And so, I mean, one thing ... this explosion of online content during the pandemic ... it strongly privileges the technologically able, cognitively typical, able-bodied, literate, and, if we're talking about in America specifically, English-fluent individuals, right? There a lot of ... in that sense, there are a lot of people who are left out of participation in the conversation.
And we think, absolutely, of course, yeah, these days the vast majority of the population does have access to the Internet. But, you know, we talk maybe ... Just a couple bits of data that I have at hand from the Pew Research Center in 2017 shows that 82% of older adults aged 65 to 69 years old have access to the Internet. But if you bump that up a few years — people over 80 — then it drops to about half, like 44% of people over the age of 80. Age of course is just one factor that is this intrinsic barrier, systemic barrier to online access, but then also other factors: socioeconomic status, people's education level, whether or not one has a disability, and of course absolutely, our deeply entrenched racial and ethnic inequities. Those all factor into the digital divide. And then you have to consider intersectionality. If one is a low-income person with a disability age 80, 83, 84, then there's just a slimmer chance of having access to all of these online resources. And, you know, these are the people that museums so often most want to reach. Certainly there are those, for whom cultural enrichment has been part of their lifelong pattern of existence, but for those who aren't coming in through our doors, those who don't even think of visiting this museum that they have never recognized as being for them or part of their culture. These are the populations we often feel so compelled to want to connect with.
HOFF: Sure, so, are there any sort of programs or efforts that jump to mind to move accessibility out of or beyond the digital space and just, for instance, get physical artworks into places where they otherwise, you know, the people who see them wouldn't otherwise see them? Things like that?
LIVINGSTON: Yeah, yeah, absolutely, right. I mean, it's like I touched on earlier one of the one of the best things we can do is to bring the museum to them. It's not always about or shouldn't always be about trying to get them through the door. Often, we're very much reliant on getting people through the doors, but also, yeah, it's a give-and-take.
So, for example, a program that for years I've had the privilege of directing involves a wonderful cadre of about 30 or so trained volunteer educators, who visit different retirement communities and older adult community spaces all around the Chicago area. Older adults who may seldom leave their retirement center just due to all these aforementioned barriers. Or people who scarcely depart from their own neighborhood, again, for various reasons. Sometimes it's just these literal physical and financial barriers, but even also just somewhat a fear of the unknown. Traversing beyond their familiar neighborhoods. So, bringing the museum to them in the form of these interactive presentations, conversations around works of art. And again, it's not really about the art historical learning. I mean there's definitely amongst older adult "lifelong learners" quote unquote, there's a strong interest in wanting to learn and expand one's horizons and acquire information. But also, even if they're learning, then we’ll mischievously also attempt to improve their well-being [laughter]. And so, something that museums have just greatly invested their time in in recent years has been, yeah, all of what we're talking about. The intersection of museum and cultural enrichment and healing, the health benefits of engaging with — well and I really come from the art perspective — but broadly museum learning, cultural enrichment, all of the arts and cultural sectors. So yeah, as the evidence increasingly shows or suggests, that yeah, cultural enrichment is good for you.
So, I also think about, you know, what about the older adult individuals who might be aging in place in their homes, don't have access to a social network, for example of a retirement community or their local place of worship or library or something of that sort. And so maybe the only person that they might see all week is the Meals on Wheels delivery person. And so, you know, how can we engage with this individual or these people, who might be facing extreme chronic loneliness and social isolation. ... I keep reading that as many as 1 in 3 Americans express feelings of loneliness, and how studies show that prolonged chronic loneliness can lead to premature death at a rate that is comparable to cigarette smoking. ... I think somewhat we're in a grip of three epidemics here. You know there's COVID-19, there's chronic loneliness and isolation, and then there's the systemic culture of violence, which leads to PTSD and other mental health issues. For museums to remain relevant in the generations ahead and today, museums are and have been and must adapt and respond, to serve as these platforms for community healing essentially.
HOFF: So, do you see that expanded role of museums as what they need to do? Or do you see them actually going in that direction in response to, I don't know, whatever kind of life comes out of, you know, our new normal in this pandemic?
LIVINGSTON: Yeah, I mean, I think it's really hard to say where we are right now and where we will be shortly, what's the long-term impact in response, and how museums might change and adapt to this. As much as we are trying to figure that out, it's very much up in the air. I think, though, we've already seen, even before this, increased interest among museums and cultural spaces to serve as places for healing, places for, really, interventions. That's kind of a word that, I don't know ... I've been tossing that around lately. This idea of like an intervention to address grief, anger, mental health, whether it's through various forms. It can be through a creative expression, through making art, or even even just through talking and socialization, through interactivity with others. And a museum can very much be a space for that. I mean, evidence even shows through studies with the National Endowment for the Arts that even just attending cultural events, attending performances, correlates, at least, correlates with prolonged life and better, healthier aging.
HOFF: As museums move into more digital spaces, into not in-person events, things like that, what might we be missing from an in-person museum experience?
LIVINGSTON: Sure, yeah, I mean, you know, it's often said, "There's nothing like being in a museum and seeing the real thing." Sure, often people have said that, I mean, I probably have said that myself, but I think also that's a very privileged and ableist comment. So, all of these systemic barriers that people face. How can we tell them, "Oh, sorry, or you're left out of a loop, because you can't come into the museum?” Definitely there's been this increase in online engagement, but then as much as museums love to evaluate everything we're doing, we've often been evaluating these physical, in-person experiences. And I think only now are many museums beginning to think about, "Okay, well, what about this online engagement?" How effective is online engagement for creating a space of community, for activating the arts for cognitive and physical health? Are we going to see that it's as effective as in-person experiences or is something missing? Is there definitely something beneficial to coming out of one's space and into a third space?
But, you know, at the same time for many people a museum can be somewhat intimidating space, for those for whom they're maybe a less accustomed, for those for whom ... and some regular visitors to the Art Institute will tell me, "This is this is like my home." But there are plenty for whom it's not their home. And so, in that sense maybe would one's ability to engage from a more familiar place of comfort, like their home, through online or even through the telephone, would that be more beneficial than if they were to go out of their way and come into the physical space. And telephone too, you know, that's something. We talked about barriers and digital divide, but ... One great measure that some museums are doing to try to mitigate the barriers to access for people, who don't enjoy the easy availability of logging online, but almost everybody, especially among the older adults, know how to use a telephone. Probably older adults more than the younger generations. They don't realize that on your smartphone there's actually a phone app [laughter]. So yeah, just having conversations over the phone. There are some great community organizations with whom we partner in Chicago and even outside of Chicago, because over the phone, you know, there's no geographic limitation there. And so, to offer cultural enrichment and even arts-based presentations over the telephone, for those older individuals who might be isolated, aging in place, living at home. Yeah, so, sometimes you don't need the most, uh, latest, greatest bells and whistles and highest technology in order to achieve the goals of arts and well-being.
HOFF: Lucas, thank you so much for spending time with us today.
LIVINGSTON: My pleasure, Tim. Thank you so much.
HOFF: That's our show. Music for this episode was by the Blue Dot Sessions. For more podcasts, articles, videos, and artwork, please visit our site, journalofethics.org. Be sure to rate, review, and share this podcast and follow us on Twitter @journalofethics for all of our latest news and updates. Thanks for listening and we'll talk to you again soon.