Longitudinal regimes of arts and cultural engagement and frailty among older adults in the United States: a g-formula approach
May 6th, 2026
A growing body of evidence links arts and cultural engagement (ACEng) with various health outcomes, however, its longitudinal relationship with frailty as a multidimensional clinical syndrome remains underexplored. This study investigated the dynamic nature of ACEng and its impact on frailty, addressing critical methodological challenges.
The Journals of Gerontology
Posted byCherry Ng
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Abstract/Description
Objectives
A growing body of evidence links arts and cultural engagement (ACEng) with various health outcomes, however, its longitudinal relationship with frailty as a multidimensional clinical syndrome remains underexplored. This study aims to investigate the dynamic nature of ACEng and its impact on frailty, addressing critical methodological challenges.
Methods
We analysed longitudinal data from 3,775 older adults (aged 50+) in the U.S. Health and Retirement Study (2005-2018). ACEng was measured as receptive cultural events (e.g. concerts, movies, museums) and two participatory activities, including (1) singing or playing a musical instrument (2) doing arts and crafts. Frailty was assessed using a 50-item frailty index covering nine health domains. Data were analysed using the g-formula approach.
Results
ACEng was highly dynamic, particularly for receptive activities. Late and sustained engagements across three ACEng activities were associated with lower levels of frailty at follow-up. However, most of these effects were sensitive to adjustments of time-varying frailty, except for sustained engagement in culture events. This sustained exposure was associated with a 0.35-point lower frailty compared to the never exposed (95% confidence interval: -0.53 to -0.17, p
A growing body of evidence links arts and cultural engagement (ACEng) with various health outcomes, however, its longitudinal relationship with frailty as a multidimensional clinical syndrome remains underexplored. This study aims to investigate the dynamic nature of ACEng and its impact on frailty, addressing critical methodological challenges.
Methods
We analysed longitudinal data from 3,775 older adults (aged 50+) in the U.S. Health and Retirement Study (2005-2018). ACEng was measured as receptive cultural events (e.g. concerts, movies, museums) and two participatory activities, including (1) singing or playing a musical instrument (2) doing arts and crafts. Frailty was assessed using a 50-item frailty index covering nine health domains. Data were analysed using the g-formula approach.
Results
ACEng was highly dynamic, particularly for receptive activities. Late and sustained engagements across three ACEng activities were associated with lower levels of frailty at follow-up. However, most of these effects were sensitive to adjustments of time-varying frailty, except for sustained engagement in culture events. This sustained exposure was associated with a 0.35-point lower frailty compared to the never exposed (95% confidence interval: -0.53 to -0.17, p
